A cystatin C cleavage ELISA assay as a quality control tool for determining sub-optimal storage conditions of cerebrospinal fluid samples in alzheimer's disease research

Kathleen Mommaerts, Eline A. J. Willemse, Monica Marchese, Catherine Larue, Wiesje M. van der Flier, Fay Betsou, Charlotte E. Teunissen

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Background: An N-terminal octapeptide cleavage of the cystatin C protein was discovered by mass spectrometry when cerebrospinal fluid (CSF) was stored at -20°C for 3 months, which did not occur when CSF was stored at -80°C. Objective: The aim was to develop an immunoassay as quality assessment tool to detect this -20°C cleavage of cystatin C in CSF and support Alzheimer's disease research. Methods: A specific monoclonal antibody and a double indirect sandwich ELISA were developed: one assay quantifies the octapeptide uncleaved protein specifically and the other quantifies the total cystatin C present in the biological fluid (both cleaved and uncleaved forms). The ratio of these concentrations was calculated to assess the extent of cleavage of cystatin C. The novel ELISA was validated and applied in a short-term (up to 4 weeks) and mid-term (up to one year) stability study of CSF stored at 4°C, -20°C, -80°C, and liquid nitrogen. Impact of freeze-thaw cycles, adsorption, and protease inhibitors were tested. Results: The ratio of truncated protein was modified following -20°C storage and seemed to reach a plateau after 6 months. The ratio was impacted neither by freeze-thaw cycles nor adsorption. The -20°C specific cleavage was found to be protease related. Conclusion: Using this novel double indirect sandwich ELISA, absolute levels of the total and uncleaved cystatin C and the ratio of truncated cystatin C can be measured. This assay is an easily applicable tool which can be used to confirm that CSF biospecimen are fit-for-purpose for Alzheimer's disease research.
Original languageEnglish
Pages (from-to)1367-1377
Number of pages11
JournalJournal of Alzheimer's Disease
Issue number3
Publication statusPublished - 2021


  • Alzheimer's disease
  • cerebrospinal fluid
  • cystatin C
  • double indirect ELISA
  • protein stability

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