Method Validation and Establishment of Reference Intervals for an Insulin-like Growth Factor-1 Chemiluminescent Immunoassay in Cats †

SIMPLE SUMMARY: Hypersomatotropism results from excess growth hormone production by a pituitary tumour and represents an important underlying cause of diabetes mellitus in cats. Diagnosis of hypersomatotropism is mainly based on the measurement of insulin-like growth factor-1 (IGF-1), ideally in combination with imaging of the head. The most well-validated assay (radioimmunoassay), however, requires facilities approved to handle radioactivity and is costly. This study validated an alternative method for IGF-1 measurement in cats, a chemiluminescence assay, and compared it to the radioimmunoassay. It also established a reference interval for IGF-1. This will increase availability of IGF-1 measurement and facilitate diagnosis of hypersomatotropism. ABSTRACT: Previously, radioimmunoassay (RIA) has been the only assay to measure insulin-like growth factor-1 (IGF-1) to diagnose hypersomatotropism (HS). Due to radiation concerns, availability, and the cost of IGF-1 RIA, validation of assays for automated analysers such as a chemiluminescent immunoassay (CLIA) is needed. The aim of this study was to validate a CLIA for measurement of feline IGF-1 (IMMULITE 2000(®) XPi, Siemens Medical Solutions Diagnostics, Malvern, PA, USA) compared to IGF1 RIA, establish reference interval (RI), and determine a cut-off value for diagnosis of HS in diabetic cats. Validation of assay performance included precision, linearity, and recovery studies. Right-sided RI was determined using surplus serum of 50 healthy adult cats. Surplus serum samples of diabetic cats with known IGF-1 concentration with (n = 32/68) and without HS (n = 36/68) were used for method comparison with RIA. The cut-off for diagnosis of HS was established using receiver operating characteristic (ROC) analysis. The intra-assay coefficient of variation (CV) was ≤4.7%, and the inter-assay CV was ≤5.6% for samples with low, medium, and high IGF-1 concentration. Linearity was excellent (R(2) > 0.99). The correlation between CLIA and RIA was very high (r(s) = 0.97), with a mean negative bias for CLIA of 24.5%. The upper limit of RI was 670 ng/mL. ROC analysis showed an area under the curve of 0.94, with best cut-off for diagnosis of HS at 746 ng/mL (sensitivity, 84.4%; specificity, 97.2%). The performance of CLIA was good, and the RI and cut-off for HS diagnosis established in this study allow for CLIA to be used in routine work-up of diabetic cats.