Susceptibility of cardiac troponin assays to biotin interference

Ithiel J. Frame, Parag Joshi, Caroline Mwangi, Ian Gunsolus, James A de Lemos, Sandeep R Das, Ravindra Sarode, Jyoti P Balani, Fred S. Apple, Alagarraju Muthukumar

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives To investigate biotin interference on three cardiac troponin (cTn) assays and demonstrate a method to overcome biotin interference. Methods cTn levels were measured in (1) plasma from healthy volunteers on 10-mg daily biotin supplementation mixed with a plasma with known elevated troponin, (2) plasmas with known elevated cTn after mixing in reagent biotin to simulate supplementation, and (3) biotin-spiked plasma specimens pretreated with streptavidin-agarose beads. Results Daily biotin ingestion (10 mg) and studies simulating daily biotin use resulted in significant interference in the Gen5 cardiac troponin T (cTnT) assay; the contemporary Gen 4 cTnT and high-sensitivity cardiac troponin I (hs-cTnI) assays were unaffected. The biotin interference threshold was 31, 315, and more than 2,000 ng/mL for Gen5 cTnT, cTnT, and hs-cTnI assays, respectively. Streptavidin pretreatment blocked biotin interference in cTn assays. Conclusions Biotin interference is possible at plasma concentrations achievable by ingestion of over-the-counter supplements that may lead to delayed or missed diagnosis of myocardial injury with the Gen5 cTnT assay.

Original languageEnglish (US)
Pages (from-to)486-493
Number of pages8
JournalAmerican Journal of Clinical Pathology
Issue number5
StatePublished - Apr 2 2019


  • Biotin
  • Interference
  • Myocardial infarction
  • Troponin

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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