Biosynthetic cerebrospinal fluid control
This is a continuation of application Ser. No. 08/080,444, filed Jun. 21, 1993, now abandoned which is a continuation of application Ser. No. 07/665,874 filed on Mar. 7, 1991, now abandoned. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to a stable biosynthetic liquid cerebrospinal fluid control and method of use. Additionally, this invention relates to the isolation and purification of stable liquid human prealbumin, a component in the biosynthetic cerebrospinal fluid control. 
     2. Description of Related Art 
     Cerebrospinal fluid is formed by an ultrafiltration of the plasma. Normal values for cerebrospinal fluid analytes are not the same as plasma values. This difference is a result of the filtration process being selective and the fact that the chemical composition is adjusted by the blood-brain barrier. Analysis of this chemical composition is an important diagnostic procedure. Disease increases cerebrospinal fluid protein concentrations. Elevated cerebrospinal fluid total protein is an indicator of central nervous system pathology such as damage to the blood-brain barrier caused by meningitis or hemorrhage. IgG is the primary immunoglobulin of cerebrospinal fluid. It is increased in several neurological conditions such as multiple sclerosis and viral meningoencephalitis. Analysis of cerebrospinal fluid by serum protein electrophoresis is an important diagnostic test in the diagnosis of multiple sclerosis. Low glucose values signal infections such as bacterial, tuberculous or fungal meningitis. Low values are also seen as a result of infiltration of the meninges with malignant cells. High lactic acid levels in cerebrospinal fluid indicate bacterial or tuberculous infection and rule out viral meningitis. Low cerebrospinal fluid chloride levels can be used as an indicator of tuberculous meningitis. 
     Since the chemical composition of cerebrospinal fluid is similar to plasma comparable tests are performed. However, the levels of these constituents are not the same resulting in different normal values than those used for plasma. In order to assess the accuracy and precision of these diagnostic tests, a control similar to cerebrospinal fluid must be run. In the case of serum protein electrophoresis, a known protein control is always run in a separate well. The protein fractions in cerebrospinal fluid are not always clearly detected. Therefore, a control in which all the serum protein fractions are clearly defined is important. Most cerebrospinal fluid controls are prepared from actual spinal fluid. There are no tests, however, to detect the presence of infectious diseases in spinal fluid. Additionally, the recovery of spinal fluid is difficult and expensive and the quality is varied. Other cerebrospinal fluid controls have been made from normal human blood serum diluted with a diluent containing glucose and chloride ions, and then lyopholized. Reconstitution of the control is then required before it can be used. See U.S. Pat. No. 3,753,925. 
     SUMMARY OF THE INVENTION 
     The present invention relates to biosynthetic cerebrospinal liquid controls based on human serum spiked with prealbumin. Two controls are disclosed: one simulating normal spinal fluid and the second simulating abnormal spinal fluid. The product is prepared from human serum and purified human prealbumin in a buffer matrix formulated to simulate human cerebrospinal fluid. In particular, this invention relates to a stable liquid human based cerebrospinal fluid control made by the process comprising: (a) combining a sufficient amount of lactic acid, chloride, glucose, serum, purified prealbumin, and potassium in a buffer to simulate normal human cerebrospinal fluid; (b) gassing said filtered fluid with oxygen to obtain normal electrophoretic pattern for human cerebrospinal fluid, and (c) filtering said fluid to remove all microbial contaminants. 
     The present invention also relates to high purity prealbumin and a process to make prealbumin. In particular, this invention relates to a purified prealbumin made by the process comprising: (a) diluting human serum with a first buffer; (b) extracting globulins, ceroplasm and albumin from normal serum diluted in a first buffer using ion exchange chromatography; (c) isolating the prealbumin containing fractions eluded from Step (b) by immunodiffusion; (d) pooling, concentrating and buffer exchanging the prealbumin containing fractions of Step (c) with a second buffer; (e) removing albumin from the said prealbumin containing pooled fractions of Step (d) by affinity chromatography; (f) isolating the prealbumin containing fractions eluted from Step (e) by immunodiffusion; (g) pooling and concentrating and buffer exchanging said prealbumin containing fractions of Step (f) with a third buffer to increase the prealbumin concentration; (h) removing globulins from said pooled fractions of Step (g) by ion exchange chromatography; (i) pooling, concentrating and buffer exchanging with a fourth buffer to increase prealbumin concentrations; (j) purifying the prealbumin containing fractions of Step (i) by gel filtration to remove any residual proteins; (k) isolating purified prealbumin fractions from Step (j) by electrophoresis and immunodiffusion; and (1) pooling, concentrating and sterile filtering said purified prealbumin fractions of Step (k). 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 shows protein electrophoresis of cerebrospinal fluid prepared according to this method. 
     FIG. 2 shows protein electrophoresis of cerebrospinal fluid prepared according to this method. 
     FIG. 3 shows protein electrophoresis of prealbumin prepared by the present method. Analysis by serum protein electrophoresis. 
     FIG. 4 shows an overlay of protein electrophoresis of prealbumin prepared by the present method, on to normal human serum pattern. 
     FIG. 5 shows protein electrophoresis of prealbumin prepared by the Raz method; analysis by serum protein electrophoresis. 
     FIG. 6 shows an overlay of protein electrophoresis of prealbumin prepared by the Raz method, onto normal human serum pattern. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The disclosed invention involves diluting human serum with constituents adjusted within ranges for cerebrospinal fluid. Cerebrospinal fluid contains a very small amount of protein as compared to serum. The protein fractions are similar to those found in serum; however, for serum the quantity of prealbumin present is less than 1% whereas the quantity present in cerebrospinal fluid is 2 to 7% of the total proteins. In order to increase the level of this protein, a prealbumin spike was added. This protein was effectively isolated from human serum using column chromatography. 
     The product is formulated by the addition of the required constituents to a 50 to 80 mM HEPES buffer matrix. The pH of the buffered matrix is 7.3. Serum and prealbumin are added to the specifications required for each level. Glucose, lactic acid, chloride, sodium, potassium are added to obtain the desired concentrations as specified in Table I. The buffered solution is then gassed with 100% oxygen to remove a pre-albumin fraction that migrates faster than prealbumin and then sterile filtered. 
     The assayed constituents for this product are: protein, glucose, lactic acid, chloride, sodium, potassium, immunoglobulins and protein fractions by electrophoresis. 
     The Level I represents normal spinal fluid. Level II represents abnormal spinal fluid. The conditions observed in both levels of the control are most commonly seen in meningitis, multiple sclerosis, and brain trauma or injuries. 
     
                       TABLE I                                                     
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          PARAMETER                                                       
                  LEVEL    LEVEL                                          
          NORMAL  I        II       UNITS                                 
______________________________________                                    
Constituent Targets:                                                      
Sodium      139-150   140-160  120-140                                    
                                      mmol/L                              
Potassium   2.7-3.9   2-4      3-6    mmol/L                              
Chloride    116-127   110-130   90-110                                    
                                      mmol/L                              
Lactic Acid 1.1-2.8   1-3      7-9    mmol/L                              
Glucose     45-80     45-80    25-40  mg/dL                               
Protein     15-45     15-45    50-80  mg/dL                               
ELECTROPHORETIC SEPARATION (% of Total Protein)                           
PREALBUMIN  2-7       2-7      2-7    %                                   
ALBUMIN     56-76     45-76    45-76  %                                   
GLOBULINS:                                                                
ALPHA 1     2-7       2-7      2-7    %                                   
BETA         7-18      7-18     7-18  %                                   
GAMMA        7-14      7-19     7-19  %                                   
IMMUNOGLOBULINS (RID)                                                     
IgA           0-0.2   trace    trace  mg/dL                               
IgG         10-40      0-15     5-40  mg/dL                               
IgM           0-0.6   trace    trace  mg/dL                               
Microbiology Specs:                                                       
            No growth to USP procedures.                                  
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     EXAMPLE 1 
     Prealbumin Isolation from Serum 
     Units of normal human serum were pooled and the volume measured to be approximately two liters. The pooled serum was diluted 50% in 50 mM potassium phosphate buffer, pH 7.5, 0.1% azide. The diluted serum was sterile filtered through a 0.22 micron filter into sterile containers. The prepared serum was then loaded on to an ion exchange column containing DEAE Sephacel™ or DEAE Sepharose™ (Pharmacia) that has been previously equilibrated with 50 mM potassium phosphate buffer, pH 7.5, 0.1% azide. After completion of the sample load, the column was washed with 50 mM potassium phosphate buffer, pH 7.5, 0.1% azide until an OD at 280 nm is less than 0.2 as measured on an UV spectrophotometer. The bound proteins were eluted with a gradient from 0 to 1M NaCl in 0.5M potassium buffer, pH 7.5, 0.1% azide. 12 mL fractions were collected until the gradient was exhausted. This column removed ceruloplasmin, globulins and albumin from the sample. 
     The fractions are tested by immunodiffusion for the presence of prealbumin. When the fractions that contain prealbumin are identified, they are pooled, concentrated, and buffer exchanged with 20 mM potassium phosphate buffer, pH 7.1, 0.02% azide. The pooled fractions were concentrated to a total protein of approximately 4 to 5 g/dL. The fraction pool is then loaded on an affinity column containing Affi Gel Blue™ (BIORAD) or Blue Sepharose™ (Pharmacia) which has been equilibrated with 20 mM phosphate buffer, pH 7.1, 0.02% azide. This chromatography media contains Cibacron Blue Dye F3G-A which has an affinity for albumin. After the sample was loaded, the fraction collector was started and 6 mL fractions were collected as the column was washed with 20 mM phosphate buffer, pH 7.1, 0.02% azide. As the sample was loaded, albumin binds to the blue dye and the remaining proteins passed through the column. The prealbumin containing fractions were pooled, concentrated and buffer exchanged with 50 mM potassium phosphate buffer, pH 7.5, 0.1% azide. The fractions were concentrated to a total protein of approximately 3 to 4 g/dL. The concentrated fractions were then loaded onto an ion exchange column containing DEAE Sephacel™ or DEAE Sepharose™ (Pharmacia) which has been equilibrated with 50 mM potassium phosphate buffer, pH 7.5, 0.1% azide. The proteins were eluted using a salt gradient of 0 to 1M NaCl in 50 mM potassium phosphate buffer, pH 7.5, 0.1% azide. Fractions of 3 mL were collected until the gradient was exhausted. Fractions were tested for the presence of prealbumin using immunodiffusion. 
     When the prealbumin containing fractions have been identified these fractions were pooled, concentrated and buffer exchanged in 50 mM phosphate buffer with 170 mM sodium chloride, pH 7.5, 0.02% azide. The fraction pool was concentrated to a total protein of approximately 2-7 g/dL. This fraction pool was then loaded on a gel filtration column which contained ULTROGEL® AcA 54 (IBF Biotechnics) equilibrated with 50 mM phosphate buffer with 170 mM sodium chloride, pH 7.5, 0.02% azide. This column was then washed with 50 mM phosphate buffer with 170 mM sodium chloride, pH 7.5, 0.02% azide. Fractions were collected of 3 mL each. Two protein peaks were collected. The prealbumin was mostly contained in the second peak. Fractions were tested for the presence of prealbumin using immunodiffusion. The fractions that contain prealbumin were then tested by serum protein electrophoresis for the presence of other serum proteins. The purified prealbumin fractions were selected, pooled and concentrated to a total protein of approximately 1 to 4 g/dL. These pooled fractions were sterile filtered and stored at 2°-8° C. 
     The purified prealbumin was tested for total prealbumin content using serum protein electrophoresis, and radial immunodiffusion analysis for quantitative measurement of prealbumin. A single peak was observed and the prealbumin was found to be 90 to 100% pure by protein electrophoresis. See FIG. 3. When compared to the electrophoretic pattern of normal serum, the peak is observed in the prealbumin region and no other serum proteins are present. See FIG. 4. When spiked into normal serum, the resulting electrophoretic pattern showed a peak in the prealbumin region. See FIG. 1 and 2. SDS PAGE electrophoresis shows a single protein to be present. This protein is found in the correct molecular weight range for prealbumin (54,000) The quantity of prealbumin demonstrated yields of 80 to 100% depending on the purity of prealbumin required. A commercially available prealbumin prepared from human plasma using the method defined by Raz, A., et al., J. Biol. Chem., 244,12 (1969) was evaluated for purity. This prealbumin was found to be only 75% pure by protein electrophoresis. See FIG. 5. When compared to the electrophoretic pattern of normal serum the contaminating proteins are observed in the albumin, and alpha globulin regions. See FIG. 6. 
     The purified prealbumin has been monitored for stability while being stored refrigerated and frozen. The prealbumin has been tested for quantity by radial immunodiffusion and purity by protein electrophoresis. After ten months storage at these conditions, the prealbumin has remained stable. 
     
                       TABLE II                                                    
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STABILITY OF PREALBUMIN                                                   
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MONTHS      STORAGE AT 2-8° C.                                     
______________________________________                                    
0           7395 mg of prealbumin/liter of solution                       
4           7020 mg of prealbumin/liter of solution                       
6           7879 mg of prealbumin/liter of solution                       
10          7005 mg of prealbumin/liter of solution                       
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MONTHS      STORAGE AT -20° C.                                     
______________________________________                                    
0           N/A                                                           
4           N/A                                                           
6           7724 mg of prealbumin/liter of solution                       
10          7275 mg of prealbumin/liter of solution                       
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     EXAMPLE 2 
     Preparation of Cerebrospinal Fluid Control 
     A clean container with a stirring device is prepared. 800 mL of distilled is placed into the container. While mixing, the following chemicals are added: 
     
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Constituents      Level I         Level II                                
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HEPES (N-2-hydroxyethyl                                                   
                  12.3   gm       9.2  gm                                 
piperazine-N.sub.2 &#39;-2-                                                   
ethane sulfonic                                                           
acid)                                                                     
Sodium HEPES      9.4    gm       7.0  gm                                 
Sodium Chloride   6.6    gm       5.3  gm                                 
Potassium Chloride                                                        
                  0.19   gm       0.3  gm                                 
Glucose           0.57   gm       0.33 gm                                 
Sodium Lactate    0.38   gm       1.5  gm                                 
Human Serum       0.29   gm       0.63 gm                                 
Prealbumin        10.0   mg       15.0 mg                                 
Sodium Azide 25%  0.8    mL       0.8  mL                                 
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     After all chemicals are dissolved, the total volume of the solution is brought to one liter with distilled water. All constituents are analyzed and adjusted within the above described specifications. A gas cylinder of oxygen is connected to a two stage regulator. Rubber tubing or equivalent is connected to the regulator and to the batching container. The first stage of the regulator is opened. The second stage is slowly opened until the gas flow through the solution is approximately 0.4 SCFH (square cubic feet per hour). While mixing, the pool is flushed in this manner at room temperature. 
     After flushing, a sample of the solution is removed and concentrated approximately 60 times. This concentrated sample is then evaluated by serum protein electrophoresis. If the electrophoretic pattern does not show a single peak in the prealbumin region, reflushing is necessary. 
     After a normal electrophoretic pattern is recovered, the solution is sterile filtered through 0.22 micron membranes into sterilized containers. The sterile solution is then filled into sterilized vials at three mL each. 
     These cerebrospinal fluid controls were evaluated for stability according to a protocol for the evaluation of the stability of diagnostics products. This protocol states guidelines for accelerated stability studies. According to this protocol, a product that is stored at 37° C. for one week is stable for one year at 2°-8° C. Accelerated stability studies were used to determine the performance characteristics of the product under storage conditions which stress the product in comparison to those recommended for use and handling of the product. The cerebrospinal fluid controls were analyzed after storage at 25° C. for three months and 37° C. for four weeks. Results from these analyses show the product to be stable and therefore have a predicted shelf life of greater than three years. The product has been monitored at 2°-8° C. for greater than one year. See Table III. 
     
                       TABLE III                                                   
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STABILITY OF CEREBROSPINAL FLUID CONTROL                                  
                                 25° C.                            
                                       37° C.                      
                        2-8° C.                                    
                                 Stor- Stor-                              
CONSTITUENTS                                                              
            UNITS       Storage  age   age                                
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LEVEL I                                                                   
PROTEIN     mg/dL       28       30    28                                 
LACTIC ACID mM          1.2      1.1   1.2                                
GLUCOSE     mg/dL       56       56    56                                 
CHLORIDE    mM          120      127   122                                
SODIUM      mM          149      150   149                                
POTASSIUM   mM          2.6      2.6   2.6                                
IgA         mg/dL       1.2      1.1   1.3                                
IgG         mg/dL       4.6      5.0   4.3                                
IgM         mg/dL       1.2      1.6   1.4                                
ELECTROPHORESIS:                                                          
PREALBUMIN  % OF TOTAL  6.2      6.2   5.2                                
ALBUMIN     % OF TOTAL  66       65    66                                 
ALPHA 1     % OF TOTAL  3.2      3.0   3.7                                
ALPHA 2     % OF TOTAL  6.3      6.3   6.2                                
BETA        % OF TOTAL  7.7      8.2   8.2                                
GAMMA       % OF TOTAL  10.5     11.2  11.6                               
LEVEL II                                                                  
PROTEIN     mg/dL       61       66    64                                 
LACTIC ACID mM          7.6      7.7   7.6                                
GLUCOSE     mg/dL       31       34    33                                 
CHLORIDE    mM          102      106   102                                
SODIUM      mM          127      127   127                                
POTASSIUM   mM          4.1      4.2   4.1                                
IgA         mg/dL       2.5      2.5   3.0                                
IgG         mg/dL       10.2     10.4  10.3                               
IgM         mg/dL       1.9      2.4   1.9                                
ELECTROPHORESIS:                                                          
PREALBUMIN  % OF TOTAL  5.4      4.9   4.6                                
ALBUMIN     % OF TOTAL  63       63    62                                 
ALPHA 1     % OF TOTAL  2.8      2.4   2.7                                
ALPHA 2     % OF TOTAL  7.4      7.6   7.8                                
BETA        % OF TOTAL  8.6      9.6   9.6                                
GAMMA       % OF TOTAL  12.5     12.6  13.5                               
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     The cerebrospinal fluid controls were also evaluated for open vial stability. Vials were tested after being open for two weeks. Analyses of the opened vials showed no change when compared to vials that were freshly sampled. See TABLE IV. 
     
                       TABLE IV                                                    
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                          FRESH    OPEN                                   
CONSTITUENT    UNITS      VIAL     14 DAYS                                
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OPEN VIAL STABILITY LEVEL I                                               
Protein        mg/dL      25.5     25.7                                   
Glucose        mg/dL      60.0     60.2                                   
Sodium         mM         158      158                                    
Chloride       mM         113      112                                    
IgG            mg/dL      4.98     4.99                                   
IgA            mg/dL      1.18     1.16                                   
IgM            mg/dL      &lt;0.69    &lt;0.69                                  
ELECTROPHORESIS:                                                          
Prealbumin     % of Total 3.6      4.4                                    
Albumin        % of Total 65       64                                     
Alpha 1        % of Total 3.0      3.6                                    
Alpha 2        % of Total 6.8      7.1                                    
Beta           % of Total 9.2      9.2                                    
Gamma          % of Total 11.9     12.1                                   
OPEN VIAL STABILITY LEVEL II                                              
Protein        mg/dL      59.5     59.1                                   
Glucose        mg/dL      33.3     33.2                                   
Sodium         mM         127      127                                    
Chloride       mM         96       97                                     
IgG            mg/dL      11       11                                     
IgA            mg/dL      2.59     2.58                                   
IgM            mg/dL      0.89     0.91                                   
ELECTROPHORESIS:                                                          
Prealbumin     % of Total 2.5      2.6                                    
Albumin        % of Total 61       62                                     
Alpha 1        % of Total 4.0      4.1                                    
Alpha 2        % of Total 8.5      7.8                                    
Beta           % of Total 10.0     9.5                                    
Gamma          % of Total 13.5     13.8                                   
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     EXAMPLE 3 
     The cerebrospinal fluid control prepared in Example 2 was used as a control in several diagnostic tests. The results of these assays are reported in TABLE V. 
     
                       TABLE V                                                     
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METHODS COMPARISON                                                        
                                       LEV-                               
           U-                    LEV-  VEL                                
CONSTITUENT                                                               
           NITS    METHOD        EL I  II                                 
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Protein    mg/dL   DuPont aca 4  28.5  59.8                               
           mg/dL   DuPont aca 3  22    57                                 
           mg/dL   Kodak Ektachem                                         
                                 25.6  75.6                               
           mg/dL   Abbott Spectrum                                        
                                 28.6  60.2                               
Lactic Acid                                                               
           mM      DuPont aca 3  1.2   7.0                                
           mM      Baxter Paramax                                         
                                 1.4   7.1                                
Glucose    mg/dL   DuPont aca 4  57.2  33.5                               
           mg/dL   DuPont aca 3  57    33.8                               
           mg/dL   DuPont Dimension                                       
                                 56.6  33.4                               
           mg/dL   Kodak Ektachem                                         
                                 60.1  35.9                               
           mg/dL   Abbott Spectrum                                        
                                 58.5  35.4                               
           mg/dL   Baxter Paramax                                         
                                 60.0  36.0                               
Chloride   mM      DuPont aca 3  122   104                                
           mM      Kodak Ektachem                                         
                                 112   93                                 
           mM      Abbott Spectrum                                        
                                 119   101                                
           mM      DuPont Dimension                                       
                                 114   97                                 
           mM      NOVA Biomedical                                        
                                 119   101                                
           mM      Baxter Paramax                                         
                                 113   95                                 
Sodium     mM      Abbott Spectrum                                        
                                 152   130                                
           mM      DuPont Dimension                                       
                                 153   128                                
           mM      NOVA Biomedical                                        
                                 150   126                                
Potassium  mM      NOVA Biomedical                                        
                                 2.7   4.1                                
IgG        mg/dL   RID           8.0   16                                 
           mg/dL   Beckman Array 5.0   11                                 
IgA        mg/dL   RID           1.4   3.0                                
           mg/dL   Beckman Array 1.2   2.6                                
IgM        mg/dL   RID           1.4   1.9                                
           mg/dL   Beckman Array &lt;0.69 0.91                               
ELECTROPHORESIS: % OF TOTAL                                               
Prealbumin     HELENA        7.0     5.5                                  
Albumin                      63      61                                   
Alpha 1                      3.8     3.9                                  
Alpha 2                      6.4     7.4                                  
Beta                         7.3     8.3                                  
Gamma                        13.0    14.0                                 
Prealbumin     BECKMAN       5.5     3.5                                  
Albumin        PARAGON       66      67                                   
Alpha 1                      3.7     3.7                                  
Alpha 2                      6.6     7.1                                  
Beta                         7.6     7.6                                  
Gamma                        10.0    11.0                                 
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