The authors thank 3D Imaging for the production of [89Zr]Zr-oxalate and Dr. Sheri Moores at Janssen Pharmaceuticals for providing antibodies.

NOTE: Refer to Figure 2 for a graphical representation of the protocol.
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/63927/63927fig02.jpg" /> 
Figure 2: Schematic of the protocol. Row and column labels are indicated as a guide for setting up the breakable 96-well plate. Anticipated binding is shown in an example well for the antigen and the BSA. The curved arrow designates the rAb that is expected to be washed out of wells with BSA only. This figure was created with BioRender.com. <a href="https://www.jove.com/files/ftp_upload/63927/63927fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
1. Buffer preparation
<ol>
	<li>Prepare 50 mL of immobilization buffer (aqueous solution of 50 mM Na2CO3; pH = 9.0).
	<ol>
		<li>Weigh 191 mg of NaHCO3 and 23.9 mg of Na2CO3 on weighing paper and transfer to a 50 mL conical tube. Add 40 mL of 18 M&#937; water and vortex to dissolve. Adjust the pH to 9.0 if needed before bringing the total volume to 50 mL with 18 M&#937; water.</li>
	</ol>
	</li>
	<li>Prepare approximately 200 mL of washing buffer (phosphate-buffered saline (PBS) containing 0.05% Tween-20) by adding 200 mL of PBS and then 100 &#181;L of Tween-20 to a 250 mL bottle.</li>
	<li>Prepare 50 mL of binding buffer (PBS containing 0.05% Tween-20, and 0.1% bovine serum albumin (BSA)).
	<ol>
		<li>Weigh 50 mg of BSA on weighing paper and transfer to a 50 mL conical tube. Add 50 mL of PBS and then 25 &#181;L of Tween-20 to the tube. Vortex gently to mix.</li>
	</ol>
	</li>
	<li>Prepare 50 mL of blocking buffer (3% BSA in PBS).
	<ol>
		<li>Weigh 1.5 g of BSA on weighing paper and transfer to a 50 mL conical tube. Add 50 mL of PBS, and vortex gently to mix. 
		NOTE: All buffers are recommended to be stored for up to 1 week at 4 &#176;C for best results.</li>
	</ol>
	</li>
</ol>
2. Antigen immobilization
<ol>
	<li>Dilute the antigen in immobilization buffer to reach a concentration of 5 &#181;g/mL.</li>
	<li>Add 100 &#181;L per well of antigen to the bottom of 24 wells of a breakable 96-well, flat-bottom plate in an 8 x 3 array (columns 1-3 for rows A-H). Cover the plate with sealing tape. 
	&#8203;NOTE: Ensure that the surface of the well-plate had been treated to maximize adsorption of mixed hydrophobic and hydrophilic domains. These pretreated plates are commercially available.</li>
	<li>Incubate at 4 &#176;C overnight.</li>
	<li>The following day, wash the plate 3x with washing buffer.
	<ol>
		<li>Invert the plate briskly in the sink to dispose of the liquid and tap the plate on a pile of paper towels to remove the excess liquid.</li>
		<li>Using a multichannel pipette, add 300 &#181;L per well of washing buffer to wells containing the antigen. Remove the liquid as described in 2.4.1. Repeat the washing step a total of three times.</li>
	</ol>
	</li>
</ol>
3. Blocking of nonspecific sites with BSA
<ol>
	<li>Using a multichannel pipette, add 300 &#181;L per well of blocking buffer to the 24 antigen-coated wells and 24 empty wells of the 96-well plate (columns 1-6 for rows A-H).</li>
	<li>Incubate the plate for 1 h at ambient temperature.</li>
	<li>Wash the plate with 300 &#181;L per well of washing buffer a total of three times. Refer to step 2.4 for a detailed description of washing the plate. 
	&#160;</li>
</ol>
4. Serial dilutions and addition of the rAb solution
CAUTION: The following steps involve radioactivity. Steps should only be performed by those with radiation safety training. Researchers should double glove and perform steps with adequate shielding.
<ol>
	<li>Synthesize the rAb under investigation using the method of choice. The rAbs used as an example were synthesized as described previously19. 
	NOTE: This protocol focuses on the characterization of a rAb once radiolabeled.</li>
	<li>Make 8 x 3-fold serial dilutions (designated for rows A-H on the plate) of the rAb in the binding buffer. 
	NOTE: The concentrations of the serial dilutions will vary for each rAb. Details are discussed in the Discussion section. If the dilution factor changes, the volume needed for each dilution should be recalculated to ensure enough volume for 1) binding of the rAb in each well, 2) seeding the following dilution, and 3) aliquoting a rAb standard solution for gamma counting to measure the radioactivity of the total rAb added to each well.
	<ol>
		<li>Calculate the volume of stock rAb needed to make a 1.2 mL solution of the first concentration (label as A).</li>
		<li>Add 800 &#181;L of binding buffer to microcentrifuge tubes labeled B, C, D, ... to&#160;H. Add 1.2 mL minus the volume calculated in step 4.2.1 of binding buffer to a microcentrifuge tube labeled A.</li>
		<li>Add the volume of stock rAb calculated in 4.2.1 to tube A. Vortex gently to mix and then spin down using a mini microcentrifuge to collect all liquid at the bottom of the tube.</li>
		<li>Add 400 &#181;L from tube A to tube B. Vortex to mix and then spin down using a mini microcentrifuge. Repeat adding from B to C, C to D, ..., G to H.</li>
	</ol>
	</li>
	<li>Add 100 &#181;L per well of each dilution to three wells immobilized with antigen and three wells blocked with BSA only. For example, add dilution A to wells A1-A3 (antigen) and A4-A6 (BSA).</li>
	<li>Add 100 &#181;L of each dilution to microcentrifuge tubes labeled A std - H std. Save these tubes as rAb standards to be assayed in the gamma counter.</li>
	<li>Incubate the plate for 1 h at 37 &#176;C with gentle rocking.</li>
</ol>
5. Wash plates and assay radioactivity
<ol>
	<li>Label microcentrifuge tubes for each well (A1 to A6, B1 to B6 ... through&#160;H1-H6). Use two different colored markers to color-code samples if desired-one for wells coated with antigen and one for wells with BSA only.</li>
	<li>Aspirate the rAb from each well using a vacuum aspirator.</li>
	<li>Using a multichannel pipette, add 300 &#181;L of washing buffer to each well. Aspirate the washing buffer. Repeat the wash a total of five times.</li>
	<li>Break apart the wells into the appropriate microcentrifuge tubes.</li>
	<li>Count the radioactivity in the tubes using a gamma counter. Count first the tubes with the antigen (H1, H2, H3 to A1, A2, A3), and then those with BSA only (H4, H5, H6 to A4, A5, A6). To minimize interference, separately count the standards for each dilution (H std to A std) at a different time.</li>
</ol>
6. Data analysis
NOTE: The supplemental files contain corresponding spreadsheet and statistical analysis templates for analyzing and plotting the data.
<ol>
	<li>In a spreadsheet, calculate the total, specific, and nonspecific binding for each sample (see the spreadsheet template attached as a supplemental file).
	<ol>
		<li>Calculate &#34;Bound Activity&#34; as the counts per minute (CPM) of the sample (obtained from the gamma counter) divided by the CPM of the appropriate standard. Calculate &#34;% Bound&#34; as Bound Activity times 100.</li>
		<li>Calculate &#34;Total Bound, mol/L&#34; by multiplying &#34;% Bound&#34; with the concentration (mol/L) of the rAb added. Calculate &#34;Total Bound, mol&#34; by multiplying &#34;Total Bound, mol/L&#34; with the volume of rAb added in liters (0.0001 L).</li>
		<li>Calculate &#34;Specific Binding, mol&#34; by subtracting &#34;Total Bound, mol&#34; of the BSA dilutions from the antigen dilutions such that A1 pairs with A4, A2 with A5, A3 with A6, B1 with B4, etc.</li>
		<li>Calculate &#34;Nonspecific Binding, mol&#34; by subtracting &#34;Specific Binding, mol&#34; from &#34;Total Binding, mol&#34; for each well.</li>
	</ol>
	</li>
	<li>In the statistical analysis plotting software, plot the concentration of rAb added (nmol/L) on the x-axis versus binding (mol) on the y-axis. Create separate groups to plot in triplicate total binding, specific binding, and nonspecific binding. Perform a nonlinear fit analysis by selecting the following parameters in the software used (Table of Materials; see the statistical analysis template attached as a supplemental file).
	<ol>
		<li>Select New Analysis. Under XY analyses, select Nonlinear regression (curve fit). Make sure all the data is selected under Analyze which data sets? and then select Ok.</li>
		<li>On the Model tab, under Binding - Saturation, select One site - Specific binding. On the Confidence tab, select Identify &#39;ambiguous&#39; fits. Leave all other parameters as default and select Ok. 
		NOTE: This will calculate the KD and Bmax for the total, specific, and nonspecific binding. The KD of the specific binding is the KD in nmol/L of the rAb bound to the antigen.</li>
	</ol>
	</li>
</ol>

<ol>
	<li>Krecisz, P., Czarnecka, K., Krolicki, L., Mikiciuk-Olasik, E., Szymanski, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiolabeled+Peptides+and+Antibodies+in+Medicine.">Radiolabeled Peptides and Antibodies in Medicine.</a> Bioconjugate Chemistry. 32 (1), 25-42 (2021).</li><li>Dun, Y., Huang, G., Liu, J., Wei, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ImmunoPET+imaging+of+hematological+malignancies:+From+preclinical+promise+to+clinical+reality.">ImmunoPET imaging of hematological malignancies: From preclinical promise to clinical reality.</a> Drug Discovery Today. 27 (4), 1196-1203 (2022).</li><li>Lohrmann, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retooling+a+Blood-Based+Biomarker:+Phase+I+assessment+of+the+high-affinity+CA19-9+antibody+HuMab-5B1+for+immuno-pet+imaging+of+pancreatic+cancer.">Retooling a Blood-Based Biomarker: Phase I assessment of the high-affinity CA19-9 antibody HuMab-5B1 for immuno-pet imaging of pancreatic cancer.</a> Clinical Cancer Research. 25 (23), 7014-7023 (2019).</li><li>Pandit-Taskar, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+phase+I/II+study+for+analytic+validation+of+89Zr-J591+immunoPET+as+a+molecular+imaging+agent+for+metastatic+prostate+cancer.">A phase I/II study for analytic validation of 89Zr-J591 immunoPET as a molecular imaging agent for metastatic prostate cancer.</a> Clinical Cancer Research. 21 (23), 5277-5285 (2015).</li><li>Rousseau, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+clinical+results+of+a+novel+immuno-PET+theranostic+probe+in+human+epidermal+growth+factor+receptor+2-negative+breast+cancer.">Initial clinical results of a novel immuno-PET theranostic probe in human epidermal growth factor receptor 2-negative breast cancer.</a> Journal of Nuclear Medicine. 61 (8), 1205-1211 (2020).</li><li>Moek, K. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Theranostics+using+antibodies+and+antibody-related+therapeutics.">Theranostics using antibodies and antibody-related therapeutics.</a> Journal of Nuclear Medicine. 58 (2), 83-90 (2017).</li><li>Chomet, M., van Dongen, G., Vugts, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=State+of+the+art+in+radiolabeling+of+antibodies+with+common+and+uncommon+radiometals+for+preclinical+and+clinical+immuno-PET.">State of the art in radiolabeling of antibodies with common and uncommon radiometals for preclinical and clinical immuno-PET.</a> Bioconjugate Chemistry. 32 (7), 1315-1330 (2021).</li><li>Kumar, K., Ghosh, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiochemistry,+production+processes,+labeling+methods,+and+immunoPET+imaging+pharmaceuticals+of+Iodine-124.">Radiochemistry, production processes, labeling methods, and immunoPET imaging pharmaceuticals of Iodine-124.</a> Molecules. 26 (2), 414 (2021).</li><li>Vosjan, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Conjugation+and+radiolabeling+of+monoclonal+antibodies+with+zirconium-89+for+PET+imaging+using+the+bifunctional+chelate+p-isothiocyanatobenzyl-desferrioxamine.">Conjugation and radiolabeling of monoclonal antibodies with zirconium-89 for PET imaging using the bifunctional chelate p-isothiocyanatobenzyl-desferrioxamine.</a> Nature Protocols. 5 (4), 739-743 (2010).</li><li>Zeglis, B. M., Lewis, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+bioconjugation+and+radiosynthesis+of+89Zr-DFO-labeled+antibodies.">The bioconjugation and radiosynthesis of 89Zr-DFO-labeled antibodies.</a> Journal of Visualized Experiments: JoVE. (96), e52521 (2015).</li><li>Wei, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ImmunoPET:+concept,+design,+and+applications.">ImmunoPET: concept, design, and applications.</a> Chemical Reviews. 120 (8), 3787-3851 (2020).</li><li>Tavar&#233;, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+effective+immuno-PET+imaging+method+to+monitor+CD8-dependent+responses+to+immunotherapy.">An effective immuno-PET imaging method to monitor CD8-dependent responses to immunotherapy.</a> Cancer Research. 76 (1), 73-82 (2016).</li><li>Tavar&#233;, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Engineered+antibody+fragments+for+immuno-PET+imaging+of+endogenous+CD8++T+cells+in+vivo.">Engineered antibody fragments for immuno-PET imaging of endogenous CD8+ T cells in vivo.</a> Proceedings of the National Academy of Sciences. 111 (3), 1108-1113 (2014).</li><li>Zeglis, B. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemoenzymatic+strategy+for+the+synthesis+of+site-specifically+labeled+immunoconjugates+for+multimodal+PET+and+optical+imaging.">Chemoenzymatic strategy for the synthesis of site-specifically labeled immunoconjugates for multimodal PET and optical imaging.</a> Bioconjugate Chemistry. 25 (12), 2123-2128 (2014).</li><li>Zeglis, B. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Enzyme-mediated+methodology+for+the+site-specific+radiolabeling+of+antibodies+based+on+catalyst-free+click+chemistry.">Enzyme-mediated methodology for the site-specific radiolabeling of antibodies based on catalyst-free click chemistry.</a> Bioconjugate Chemistry. 24 (6), 1057-1067 (2013).</li><li>Kristensen, L. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Site-specifically+labeled+89Zr-DFO-trastuzumab+improves+immuno-reactivity+and+tumor+uptake+for+immuno-PET+in+a+subcutaneous+HER2-positive+xenograft+mouse+model.">Site-specifically labeled 89Zr-DFO-trastuzumab improves immuno-reactivity and tumor uptake for immuno-PET in a subcutaneous HER2-positive xenograft mouse model.</a> Theranostics. 9 (15), 4409-4420 (2019).</li><li>Maguire, J. J., Kuc, R. E., Davenport, A. P., Davenport, A. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Radioligand binding assays and their analysis. in Receptor Binding Techniques. , 31-77 (2012).</li><li>Davenport, A. P., Russell, F. D., Mather, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radioligand+bindsing+assays:+theory+and+practice.">Radioligand bindsing assays: theory and practice.</a> Current Directions in Radiopharmaceutical Research and Development. , 169-179 (1996).</li><li>Cavaliere, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+[89Zr]ZrDFO-amivantamab+bispecific+to+EGFR+and+c-MET+for+PET+imaging+of+triple+negative+breast+cancer.">Development of [89Zr]ZrDFO-amivantamab bispecific to EGFR and c-MET for PET imaging of triple negative breast cancer.</a> European Journal of Nuclear Medicine and Molecular Imaging. 48 (2), 383-394 (2021).</li><li>Marquez, B. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+(89)Zr-pertuzumab+in+breast+cancer+xenografts.">Evaluation of (89)Zr-pertuzumab in breast cancer xenografts.</a> Molecular Pharmaceutics. 11 (11), 3988-3995 (2014).</li><li>Marquez-Nostra, B. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preclinical+PET+imaging+of+glycoprotein+non-metastatic+melanoma+B+in+triple+negative+breast+cancer:+feasibility+of+an+antibody-based+companion+diagnostic+agent.">Preclinical PET imaging of glycoprotein non-metastatic melanoma B in triple negative breast cancer: feasibility of an antibody-based companion diagnostic agent.</a> Oncotarget. 8 (61), 104303-104314 (2017).</li><li>Ghai, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+[(89)Zr]DFO-elotuzumab+for+immunoPET+imaging+of+CS1+in+multiple+myeloma.">Development of [(89)Zr]DFO-elotuzumab for immunoPET imaging of CS1 in multiple myeloma.</a> European Journal of Nuclear Medicine and Molecular Imaging. 48 (5), 1302-1311 (2021).</li><li>McKnight, B. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Imaging+EGFR+and+HER3+through+(89)Zr-labeled+MEHD7945A+(Duligotuzumab).">Imaging EGFR and HER3 through (89)Zr-labeled MEHD7945A (Duligotuzumab).</a> Scientific Reports. 8 (1), 1-13 (2018).</li></ol>

The authors have no conflicts of interest.

As part of the development of rAbs, it is important to ensure a rAb binds specifically to its target with high binding affinity. Determining binding affinity can inform if the immunoreactivity of the rAb is affected by radioconjugation through the radioligand saturation assay using immobilized antigen. Determining rAb binding to BSA can be used to quantify nonspecific binding to measure specific binding to the immobilized antigen more accurately. This method tests the binding of different concentrations of rAb to generat...

Radiolabeled antibodies (rAb) have a variety of uses in medicine. While the majority are utilized in oncology as imaging and therapeutic agents, there are imaging applications for rheumatology-related inflammation, cardiology, and neurology1. Imaging rAbs has high sensitivity to detect lesions and has the potential to aid in patient selection for treatment2,3,4,5. They are also used for therapy because of their specificity for their respective antigens. In a strategy known as theranostics, the same rAb is used for both imaging and treatment6.
Ideally, the antibody chosen for radiolabeling is one already proven to have high binding affinity and specificity using non-radiolabeled methods. Radiolabeling of antibodies can be achieved via direct chemical modification of antibodies with a radionuclide that forms stable covalent bonds (eg. radioiodine), or indirectly via conjugation with chelators that subsequently coordinate to radiometals7,8. Direct radiolabeling such as with radioiodine specifically modifies tyrosine and histidine residues on the antibody. If these residues are important for antigen binding, then this radioconjugation would alter the binding affinity. Conversely, there are multiple established protocols for the conjugation and indirect radiolabeling of antibodies. For example, a common chelator used to bind zirconium-89 (89Zr) for PET imaging of antibodies is the p-isothiocyanatobenzyl-desferrioxamine (DFO), which is conjugated randomly to lysine residues of the antibody9,10. If there are lysine residues at the antigen-binding region, conjugation at these sites could sterically hinder antigen binding and therefore compromise the antibody-antigen binding. Thus, the different radioconjugation methods used for indirect or direct radiolabeling of antibodies can potentially affect immunoreactivity, defined as the ability of the antibody radioconjugate to bind to its antigen7,11. Site-specific conjugation methods can circumvent this limitation, but these techniques require antibody engineering to incorporate additional cysteine residues or expertise in enzymatic reactions on carbohydrate residues12,13,14,15,16. Once an antibody is radiolabeled, it is important to test if immunoreactivity is retained as part of the characterization of the rAb. One way to measure immunoreactivity is to determine the rAb&#39;s binding affinity.
The purpose of this protocol is to describe a process for determining the binding affinity for rAbs using an established radioligand saturation assay to quantify rAb-antigen binding. The binding trend is outlined in Figure 1. The amount of antigen bound will increase as more rAb is added to a fixed amount of immobilized antigen. Once all antigen-binding sites are saturated, a plateau will be reached, and adding more rAbs will have no effect on the amount of bound antigen. In this model, the equilibrium dissociation constant (KD)&#160;is the concentration of antibody that occupies half of the antigen receptors17. The KD represents how well an antibody binds to its target with a lower KD corresponding to a higher binding affinity. It was previously reported that an ideal rAb should have a KD of 1 nanomolar or less18. However, more recent rAbs have been developed with KD in the low nanomolar range, and are considered suitable for noninvasive imaging applications19,20,21,22. Another parameter that can be determined in the radioligand saturation assay of rAbs is Bmax,&#160;which corresponds to the maximum amount of antigen-binding. Bmax can be used to calculate the number of antigen molecules if needed.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/63927/63927fig01.jpg" /> 
Figure 1: Representative saturation binding curve. The percentage of antigen bound is plotted against increasing concentrations of antibodies added to a fixed amount of antigen. Pop-outs demonstrate binding at various points. The concentration and binding corresponding to KD and Bmax, respectively, are shown. This figure was created with BioRender.com. <a href="https://www.jove.com/files/ftp_upload/63927/63927fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
This assay is particularly important for radiolabeled bispecific antibody constructs to determine the KD for each fragment antigen-binding region (Fab) arm of the radiolabeled bispecific antibody binding with their respective antigens. This protocol can be used to determine the KD of each Fab arm separately on immobilized antigens to independently characterize whether the binding affinity of each Fab arm for its respective antigen was affected after radioconjugation. This protocol is demonstrated by the use of radiolabeled amivantamab, a bispecific antibody for epidermal growth factor receptor (EGFR) and cytoplasmic mesenchymal-epithelial transition (cMET) proteins19. Radiolabeled single-arm antibodies, where one Fab arm binds to EGFR (&#945;-EGFR) or to cMET (&#945;-cMET) and the other Fab arm is an isotype control, were also used as examples19. This protocol is also appropriate for any radiolabeled antibody with a known antigen that can be immobilized. In this protocol, a dilution series of the rAb is added to a fixed amount of immobilized antigen in designated wells specific for each Fab arm of the rAb. The rAb is also added to wells that have only been blocked with bovine serum albumin (BSA), without antigen, to determine nonspecific binding. To determine specific binding, nonspecific binding to immobilized antigen is subtracted from the total rAb binding. The resulting saturation binding curve is then used to determine KD, as described above.
One advantage of this method is higher reproducibility when using purified antigens compared with using cell lines as the source of antigens, given that antigen expression levels could be affected during cell culture and that different cell lines have variable levels of antigen expression. In the case of radiolabeled bispecific antibodies, cell lines that only express one of the antigens without the other may not be available, which would make characterizing the binding affinity of the individual Fab arms very challenging. Notably, the key advantage of the radioligand saturation assay method over non-radiolabeled methods is the specific characterization of the binding affinity of the rAb without the contribution of the rAb&#39;s unconjugated fraction. To the best of the authors&#39; knowledge, there are currently no purification techniques to separate the rAb from its parent unconjugated antibody. Given the relatively small size of the chelator and radionuclide, their contribution to the overall molecular weight of the rAb is insignificant in size exclusion chromatography. Thus, the product generated from any radiolabeling technique is almost always a mixture of the rAb and its parent unconjugated antibody. Characterizing binding affinity using the radiolabeled saturation assay ensures that the product being tested is solely the rAb.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Bovine Serum Albumin (BSA)</td>
			<td>Sigma-Aldrich</td>
			<td>A9647</td>
			<td></td>
		</tr>
		<tr>
			<td>Gamma Counter</td>
			<td>Hidex</td>
			<td>Hidex Automatic Gamma Counter</td>
			<td></td>
		</tr>
		<tr>
			<td>GraphPad Prism Software</td>
			<td>GraphPad</td>
			<td></td>
			<td>version 9.2; used for statistical analyses in this study</td>
		</tr>
		<tr>
			<td>Immuno Breakable MaxiSorp 96-well plates</td>
			<td>Thermo Scientific</td>
			<td>473768</td>
			<td></td>
		</tr>
		<tr>
			<td>Microplate Sealing Tape</td>
			<td>Corning</td>
			<td>4612</td>
			<td></td>
		</tr>
		<tr>
			<td>Microsoft Excel</td>
			<td>Microsoft</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Phosphate Buffered Saline (PBS)</td>
			<td>Gibco</td>
			<td>14190144</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Bicarbonate</td>
			<td>JT Baker</td>
			<td>3506-01</td>
			<td></td>
		</tr>
		<tr>
			<td>Sodium Carbonate</td>
			<td>Sigma-Aldrich</td>
			<td>S7795</td>
			<td></td>
		</tr>
		<tr>
			<td>Tween-20</td>
			<td>Sigma-Aldrich</td>
			<td>P7949</td>
			<td></td>
		</tr>
	</tbody>
</table>

determining binding affinity (kd) of radiolabeled antibodies to immobilized antigens

Determining binding affinity (KD) is an important aspect of the characterization of radiolabeled antibodies (rAb). Typically, binding affinity is represented by the equilibrium dissociation constant, KD, and can be calculated as the concentration of antibody at which half the antibody binding sites are occupied at equilibrium. This method can be generalized to any radiolabeled antibody or other protein and peptide scaffolds. In contrast to cell-based methods, the choice of immobilized antigens is particularly useful for validating binding affinities after long-term storage of antibodies, distinguishing binding affinities of fragment antigen-binding region (Fab) arms in bispecific antibody constructs, and determining if there is variability in antigen expression between different cell lines. This method involves immobilizing a fixed amount of antigen to specified wells on a breakable 96-well plate. Then, nonspecific binding was blocked in all wells with bovine serum albumin (BSA). Subsequently, the rAb was added in a concentration gradient to all wells. A range of concentrations was chosen to allow the rAb to reach saturation, i.e., a concentration of antibody at which all antigens are continuously bound by the rAb. In designated wells without immobilized antigen, nonspecific binding of the rAb can be determined. By subtracting nonspecific binding from total binding in the wells with immobilized antigen, specific binding of the rAb to the antigen can be determined. The KD of the rAb was calculated from the resulting saturation binding curve. As an example, binding affinity was determined using radiolabeled amivantamab, a bispecific antibody for epidermal growth factor receptor (EGFR) and cytoplasmic mesenchymal-epithelial transition (cMET) proteins.

This method calculates binding affinity (KD) for a rAb based on the saturation binding assay where different concentrations of rAb were added to a fixed amount of immobilized antigen. The binding curve should follow logarithmic growth where it is initially steep and then plateaus as the antigen is saturated. To ensure the determined KD is accurate, the concentrations of rAb must be high enough to reach saturation. For this assay, radiolabeled antibodies were conjugated to DFO and radiolabeled with <...

Watch this Scientific Journal Video about Determining Binding Affinity KD of Radiolabeled Antibodies to Immobilized Antigens at JoVE.com

Determining Binding Affinity KD of Radiolabeled Antibodies to Immobilized Antigens

Here, a method is described to determine the binding affinity (KD) of radiolabeled antibodies to immobilized antigens. KD is the equilibrium dissociation constant that can be determined from a saturation binding experiment by measuring the total, specific, and nonspecific binding of a radiolabeled antibody at various concentrations to its antigen.

Determining Binding Affinity (KD) of Radiolabeled Antibodies to Immobilized Antigens

Determining binding affinity (KD) is an important aspect of the characterization of radiolabeled antibodies (rAb). Typically, binding affinity is ...

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Research

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Medicine

5.7K Views.  Yale University. Here, a method is described to determine the binding affinity (KD) of radiolabeled antibodies to immobilized antigens. KD is the equilibrium dissociation constant that can be determined from a saturation binding experiment by measuring the total, specific, and nonspecific binding of a radiolabeled antibody at various concentrations to its antigen.

Video: Determining Binding Affinity KD of Radiolabeled Antibodies to Immobilized Antigens

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

Determining Glucose Metabolism Kinetics Using 18F-FDG Micro-PET/CT

This paper describes the use of 18F-FDG and micro-PET/CT imaging to determine in vivo glucose metabolism kinetics in mice (and is transferable to rats). Impaired uptake and metabolism of glucose in multiple organ systems due to insulin resistance is a hallmark of type 2 diabetes. The ability of this technique to extract an image-derived input function from the vena cava using an iterative deconvolution method eliminates the requirement of the collection of arterial blood samples. Fitting of tissue and vena cava time activity curves to a two-tissue, three compartment model permits the estimation of kinetic micro-parameters related to the 18F-FDG uptake from the plasma to the intracellular space, the rate of transport from intracellular space to plasma and the rate of 18F-FDG phosphorylation. This methodology allows for multiple measures of glucose uptake and metabolism kinetics in the context of longitudinal studies and also provides insights into the efficacy of therapeutic interventions.

Determining Glucose Metabolism Kinetics Using 18F-FDG Micro-PET/CT

This study describes a protocol that uses 18F-FDG and positron emission tomography/computed tomography (PET/CT) imaging, together with kinetic modelling, to quantify the in vivo, real-time uptake of 18F-FDG into tissues.

This paper describes the use of 18F-FDG and micro-PET/CT imaging to determine in vivo glucose metabolism kinetics in mice (and is transferable to rats). ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Determining and Controlling External Power Output During Regular Handrim Wheelchair Propulsion

The use of a manual wheelchair is critical to 1% of the world&#39;s population. Human powered wheeled mobility research has considerably matured, which has led to improved research techniques becoming available over the last decades. To increase the understanding of wheeled mobility performance, monitoring, training, skill acquisition, and optimization of the wheelchair-user interface in rehabilitation, daily life, and sports, further standardization of measurement set-ups and analyses is required. A crucial stepping-stone is the accurate measurement and standardization of external power output (measured in Watts), which is pivotal for the interpretation and comparison of experiments aiming to improve rehabilitation practice, activities of daily living, and adaptive sports. The different methodologies and advantages of accurate power output determination during overground, treadmill, and ergometer-based testing are presented and discussed in detail. Overground propulsion provides the most externally valid mode for testing, but standardization can be troublesome. Treadmill propulsion is mechanically similar to overground propulsion, but turning and accelerating is not possible. An ergometer is the most constrained and standardization is relatively easy. The goal is to stimulate good practice and standardization to facilitate the further development of theory and its application among research facilities and applied clinical and sports sciences around the world.

Accurate and standardized assessment of external power output is crucial in the evaluation of physiological, biomechanical, and perceived stress, strain, and capacity in manual wheelchair propulsion. The current article presents various methods to determine and control power output during wheelchair propulsion studies in the laboratory and beyond.

The use of a manual wheelchair is critical to 1% of the world&#39;s population. Human powered wheeled mobility research has considerably matured, which ...

Monitoring PD-1-Blocking Antibodies Bound to T Cells Derived from a Drop of Peripheral Blood

Immune checkpoint inhibitors, including PD-1&#8211;blocking antibodies, have significantly improved treatment outcomes in various types of cancer. The pharmacological efficacy of these immunotherapies is long lasting, extending even beyond the discontinuation of their injections, due to persistent blood concentrations. Here we developed a simple flow cytometry assay to evaluate the T cell binding status of the PD-1&#8211;blocking antibodies nivolumab and pembrolizumab. Like a glucose test, this assay requires just a single drop of peripheral blood. Visualizing antibody binding on T cells is more reliable than measuring antibody blood concentrations. In addition, if necessary, we can potentially analyze many distinctive immune-related markers on T cells bound to PD-1&#8211;blocking antibodies. Thus, this is a simple and minimally invasive strategy to analyze the pharmacological effect of PD-1&#8211;blocking antibodies in cancer patients.

We developed a simple flow cytometry assay for evaluating the binding of PD-1&#8211;blocking antibodies to T cells, requiring only a drop of peripheral blood from cancer patients.

Immune checkpoint inhibitors, including PD-1&#8211;blocking antibodies, have significantly improved treatment outcomes in various types of cancer. The ...

Biological Preparation and Mechanical Technique for Determining Viscoelastic Properties of Zonular Fibers

Elasticity is essential to the function of tissues such as blood vessels, muscles, and lungs. This property is derived mostly from the extracellular matrix (ECM), the protein meshwork that binds cells and tissues together. How the elastic properties of an ECM network relate to its composition, and whether the relaxation properties of the ECM play a physiological role, are questions that have yet to be fully addressed. Part of the challenge lies in the complex architecture of most ECM systems and the difficulty in isolating ECM components without compromising their structure. One exception is the zonule, an ECM system found in the eye of vertebrates. The zonule comprises fibers hundreds to thousands of micrometers in length that span the cell-free space between the lens and the eyewall. In this report, we describe a mechanical technique that takes advantage of the highly organized structure of the zonule to quantify its viscoelastic properties and to determine the contribution of individual protein components. The method involves dissection of a fixed eye to expose the lens and the zonule and employs a pull-up technique that stretches the zonular fibers equally while their tension is monitored. The technique is relatively inexpensive yet sensitive enough to detect alterations in viscoelastic properties of zonular fibers in mice lacking specific zonular proteins or with aging. Although the method presented here is designed primarily for studying ocular development and disease, it could also serve as an experimental model for exploring broader questions regarding the viscoelastic properties of elastic ECM&#39;s and the role of external factors such as ionic concentration, temperature, and interactions with signaling molecules.

The protocol describes a method for the study of extracellular matrix viscoelasticity and its dependence on protein composition or environmental factors. The matrix system targeted is the mouse zonule. The performance of the method is demonstrated by comparing the viscoelastic behavior of wild-type zonular fibers with those lacking microfibril-associated glycoprotein-1.

Elasticity is essential to the function of tissues such as blood vessels, muscles, and lungs. This property is derived mostly from the extracellular ...

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

The benefits of renal sympathetic denervation (RDN) on blood pressure have been proved in a large number of clinical trials in recent years. However, the regulatory mechanism of RDN on hypertension remains elusive. Thus, it&#39;s essential to establish a simpler RDN model in mice. In this study, osmotic mini pumps filled with Angiotensin II were implanted in 14-week-old C57BL/6 mice. One week after the implantation of the mini-osmotic pump, a modified RDN procedure was performed on bilateral renal arteries of the mice using phenol. Age-sex-matched mice were given saline and served as sham group. Blood pressure was measured at baseline and every week subsequently for 21 days. Then, renal artery, abdominal aorta and heart were collected for histological examination using H&#38;E and Masson staining. In this study, we present a simple, practical, repeatable, and standardized RDN model, which can control hypertension and alleviate cardiac hypertrophy. The technique can denervate peripheral renal sympathetic nerves without renal artery damage. Compared to previous models, the modified RDN facilitates the study of the pathobiology and pathophysiology of hypertension.

Here, we present a protocol for renal sympathetic denervation (RDN) in mice with hypertension induced by Angiotensin II infusion. The procedure is repeatable, convenient and allows to study the regulatory mechanisms of RDN on hypertension and cardiac hypertrophy.

The benefits of renal sympathetic denervation (RDN) on blood pressure have been proved in a large number of clinical trials in recent years. However, the ...

Network Pharmacology Prediction and Experimental Validation of Trichosanthes-Fritillaria thunbergii Action Mechanism Against Lung Adenocarcinoma

We aimed to study the mechanism of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma (LUAD) based on network pharmacology and experimental verification. The effective components and potential targets of Trichosanthis and Fritillaria thunbergii were collected by high-throughput experiment and reference-guided (HERB) database of traditional Chinese medicine and a similarity ensemble approach (SEA) database, and the LUAD-related targets were queried by the GeneCards and Online Mendelian Inheritance in Man (OMIM) databases. A drug-component-disease-target network was constructed by Cytoscape software. Protein-protein interaction (PPI) network, gene ontology (GO) function, and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analyses were conducted to obtain core targets and key pathways. An aqueous extract of Trichosanthes-Fritillaria thunbergii and A549 cells were used for the subsequent experimental validation. Through the HERB database and literature search, 31 effective compounds and 157 potential target genes of Trichosanthes-Fritillaria thunbergii were screened, of which 144 were regulatory targets of Trichosanthes-Fritillaria thunbergii in the treatment of lung adenocarcinoma. The GO functional enrichment analysis showed that the mechanism of action of Trichosanthes-Fritillaria thunbergii against lung adenocarcinoma is mainly protein phosphorylation. The KEGG pathway enrichment analysis suggested that the treatment of lung adenocarcinoma by Trichosanthes-Fritillaria thunbergii mainly involves the PI3K/AKT signaling pathway. The experimental validation showed that an aqueous extract of Trichosanthes-Fritillaria thunbergii could inhibit the proliferation of A549 cells and the phosphorylation of AKT. Through network pharmacology and experimental validation, it was verified that the PI3K/AKT signaling pathway plays a vital role in the action of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma.

Network Pharmacology Prediction and Experimental Validation of Trichosanthes-Fritillaria thunbergii Action Mechanism Against Lung Adenocarcinoma

This study reveals the mechanism of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma based on network pharmacology and experimental verification. The study also demonstrates that the PI3K/AKT signaling pathway plays a vital role in the action of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma.

We aimed to study the mechanism of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma (LUAD) based on network pharmacology and ...

Standardized Tuina Manipulation for Knee Osteoarthritis in Rats

Tuina Manipulation to Reduce Inflammation and Cartilage Loss in Knee Osteoarthritis Rats

Clinical trials suggest that Tuina manipulation is effective in treating knee osteoarthritis (KOA), while further studies are required to discover its mechanism. Therefore, the manipulation of animal models of knee osteoarthritis is critical. This protocol provides a standard process for Tuina manipulation on KOA rats and a preliminary exploration of the mechanism of Tuina for KOA. The press and kneading manipulation method (a kind of Tuina manipulation that refers to pressing and kneading the specific area of the body surface) is applied on 5 acupoints around the knee joint of rats. The force and frequency of the manipulation were standardized by finger pressure recordings, and the position of the rat during manipulation is described in detail in the protocol. The effect of manipulation can be measured by pain behavior tests and microscopic findings in synovial and cartilage. KOA rats showed significant improvement in pain behavior. The synovial tissue inflammatory infiltration was reduced in the Tuina group, and the expression of tumor necrosis factor (TNF)-&#945; was significantly lower. Compared to the control group, chondrocyte apoptosis was less in the Tuina group. This study provides a standardized protocol for Tuina manipulation on KOA rats and preliminary proof that the therapeutic effects of Tuina may be related to reducing synovial inflammation and delayed chondrocyte apoptosis.

Author Spotlight: Understanding the Mechanism of Tuina Manipulation in Rats 

We present a protocol for Tuina manipulation performed on plaster-immobilized-induced knee osteoarthritis rats. Based on the preliminary results, it suggested that the efficacy of the method relied on the reduction of inflammation and cartilage loss.

Clinical trials suggest that Tuina manipulation is effective in treating knee osteoarthritis (KOA), while further studies are required to discover its ...

Standardized Tuina Protocol for Rat DRG Compression Model

Analgesic Effect of Tuina on Rat Models with Compression of the Dorsal Root Ganglion Pain

Neuropathic pain is a prevalent condition that affects 6.9%-10% of the population and results from nerve damage due to various etiologies, such as lumbar disc herniation, spinal canal stenosis, and intervertebral foramen stenosis. Although Tuina, a traditional Chinese manual therapy, has shown analgesic effects in clinical practice for the treatment of neuropathic pain, its underlying neurobiological mechanisms remain unclear. Animal models are essential for elucidating the basic principles of Tuina. In this study, we propose a standardized Tuina protocol for rats with compression of the dorsal root ganglion (DRG), which involves inducing DRG compression by inserting a stainless steel rod into the intervertebral foramen, performing Tuina manipulation with specific parameters of location, intensity, and frequency in a controlled environment, and assessing the behavioral and histopathological outcomes of Tuina treatment. This article also discusses the potential clinical implications and limitations of the study and suggests directions for future research on Tuina.

Author Spotlight: Analgesic Effect of Tuina on Rat Models with Compression of the Dorsal Root Ganglion Pain  

This article presents a manipulation for treating chronic compression of the dorsal root ganglion in rats using Tuina therapy, along with a method for evaluating its effectiveness based on pain behavior and histopathological results.

Neuropathic pain is a prevalent condition that affects 6.9%-10% of the population and results from nerve damage due to various etiologies, such as lumbar ...