Susceptibility of cardiac troponin assays to biotin interference

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

Research output: Contribution to journalArticlepeer-review

21 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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