Clinical evaluation of an aerolysin-based screening test for paroxysmal nocturnal haemoglobinuria

Recently, a toxin produced by Aeromonas hydrophila was demonstrated to bind directly to the glycosyl-phosphatidyl-inositol (GPI) anchor. After coupling it to a fluorescent dye and applying it in fluorescence-activated cell scanning (FACS), this property was exploited to detect GPI-negative cells in the diagnosis of paroxysmal nocturnal haemoglobinuria (PNH).

We used this reagent according to a very simple staining protocol followed by single-colour FACS and compared the results in patients with PNH and normal controls with those obtained with antibody-mediated detection of cells lacking GPI-anchored proteins.

We observed very good concordance between the two methods, with correlation coefficients (R2) of quantified GPI-deficient cell populations ranging from 0.952 to 0.969. The lower limit of detection was determined at 0.50% GPI-negative cells, which was in the range obtained with double-colour staining with antibodies (0.20-1.00%, depending on the antibody). A significant correlation was observed between the fraction of GPI-negative granulocytes and laboratory parameters of haemolysis, with the erythrocyte creatine having the best correlation (R2 = 0.671, P < 0.0001).

Using this protocol, we were able to reliably diagnose PNH with a high sensitivity. The test allows the identification of GPI-negative granulocyte populations as small as 0.5%.