How accurate is your sclerostin measurement? Comparison between two commercially available sclerostin ELISA kits

Introduction: Sclerostin (SOST), osteocyte-secreted soluble antagonist of the Wnt/β-catenin signaling pathway, is a potent inhibitor of osteoblastogenesis. Circulating SOST levels have been measured in a plethora of disorders such as ankylosing spondylitis, chronic kidney disease, diabetes, fractures, hypercortisolism, multiple myeloma and spinal cord injury. SOST is a crucial regulator of the skeletal anabolic action of PTH and as so, anti-sclerostin antibodies are being investigated as potential therapeutic molecules for metabolic bone diseases. Accurate measurement of SOST is therefore of utmost importance for the diagnosis of bone disorders and therapy effectiveness. However, reports so far suggests further study is needed before SOST measurements are introduced into routine clinical practice.
Objective: To compare two commercially available assays for measurement of circulating SOST.
Method: EDTA-plasma samples from 36 anonymised healthy individuals were analyzed using ELISA kit for circulating SOST from Biomedica (Vienna, Austria) and TecoMedical (TECO, Sissach, Switzerland). Both assays are based on immuno-capture using two antibodies which have been raised against human recombinant SOST and are highly specific for this molecule.
Results: Circulating SOST levels in EDTA plasma samples were found to be significantly different between TECO and Biomedica assays (36.9 ± 2 and 21.3 ± 1pmol/L, respectively, p<0.001) with discrepancies of up to 32pmol/L. The TECO assay demonstrated less variability between duplicates (2.6±2.4 % and 7.4±6.3 % respectively) and dilution study showed that the biomedical kit over-recovered diluted samples by up to 60%. When samples containing various concentrations of endogenous sclerostin were spiked with a known amount of SOST, recovery was 88.5% and 104% respectively.
Conclusion: The variability in values generated from Biomedica and TECO assays has raised questions regarding the specificity of antibodies used by the two manufactures, and whether there is possible interference affecting one of the assays remains unclear. Cross-reactivity experiments are being conducted to determine the source of variation between the two kits. Until such issues are resolved, measurement of sclerostin remains invaluable for understanding the mechanism by which osteocytes regulate bone turnover but should be used in discretion and interpretation should be carried out with guided clinical evidence.