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Peer-reviewedCC BYJournal of clinical laboratory analysis

Standardization of the Monocyte Monolayer Assay: Lessons Learned From Laboratory Optimization and Literature Review.

  1. 1Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.

Abstract

Objectives

Several variables influence the outcome of cellular assays. We conducted a comprehensive literature review to identify the factors affecting the Monocyte Monolayer Assay (MMA) and subsequently standardized the assay through systematic in-house laboratory trials.Methods

The study was conducted in two phases. Phase 1 involved a literature review using PubMed and Scopus databases to identify factors influencing the assay. Phase 2 included experimental trials to evaluate the effects of these factors. Monocytes were isolated from buffy coat bags, and assay parameters, such as centrifugation speed, monocyte adherence conditions, RBC sensitization, incubation time, and staining, were systematically standardized. A blinded evaluation was employed for slide reading to assess the influence of procedural factors on assay reliability.Results

A literature review using the PubMed and Scopus databases identified key variables influencing MMA performance. Twelve sequential trials were conducted to identify the effects of these variables on assay outcome. Optimal centrifugation speed and time was 600 × g for 15 min, and the use of four buffy coat bags improved monocyte yield to 8.3 × 10⁶/mL. Dilution with Phosphate buffer saline (PBS, pH 7.2) and use of Histopaque provided consistent cell recovery. A 1-h incubation yielded optimal monocyte adherence with minimal lysis. The final protocol demonstrated high reproducibility and improved visualization of phagocytosis.Conclusion

This study emphasizes the importance of standardizing the MMA procedure before implementation. Optimizing the parameters to ensure enhanced monocyte yield, reduced cell lysis, and reliable interpretation for assessing the clinical significance of red cell alloantibodies is essential.

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BibTeX
@article{shastry2026standardization,
  title = {{Standardization of the Monocyte Monolayer Assay: Lessons Learned From Laboratory Optimization and Literature Review.}},
  author = {Shamee Shastry and Kavya Babu and Deepika Chenna and Ganesh Mohan and Kartik Iyer},
  journal = {Journal of clinical laboratory analysis},
  year = {2026},
  month = oct,
  doi = {10.1002/jcla.70381},
  url = {https://europepmc.org/article/MED/42899374},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Standardization of the Monocyte Monolayer Assay: Lessons Learned From Laboratory Optimization and Literature Review.
AU  - Shamee Shastry
AU  - Kavya Babu
AU  - Deepika Chenna
AU  - Ganesh Mohan
AU  - Kartik Iyer
PY  - 2026
DA  - 2026/10/20
JO  - Journal of clinical laboratory analysis
DO  - 10.1002/jcla.70381
UR  - https://europepmc.org/article/MED/42899374
AB  - Objectives  Several variables influence the outcome of cellular assays. We conducted a comprehensive literature review to identify the factors affecting the Monocyte Monolayer Assay (MMA) and subsequently standardized the assay through systematic in-house laboratory trials.Methods  The study was conducted in two phases. Phase 1 involved a literature review using PubMed and Scopus databases to identify factors influencing the assay. Phase 2 included experimental trials to evaluate the effects of these factors. Monocytes were isolated from buffy coat bags, and assay parameters, such as centrifugation speed, monocyte adherence conditions, RBC sensitization, incubation time, and staining, were systematically standardized. A blinded evaluation was employed for slide reading to assess the influence of procedural factors on assay reliability.Results  A literature review using the PubMed and Scopus databases identified key variables influencing MMA performance. Twelve sequential trials were conducted to identify the effects of these variables on assay outcome. Optimal centrifugation speed and time was 600 × g for 15 min, and the use of four buffy coat bags improved monocyte yield to 8.3 × 10⁶/mL. Dilution with Phosphate buffer saline (PBS, pH 7.2) and use of Histopaque provided consistent cell recovery. A 1-h incubation yielded optimal monocyte adherence with minimal lysis. The final protocol demonstrated high reproducibility and improved visualization of phagocytosis.Conclusion  This study emphasizes the importance of standardizing the MMA procedure before implementation. Optimizing the parameters to ensure enhanced monocyte yield, reduced cell lysis, and reliable interpretation for assessing the clinical significance of red cell alloantibodies is essential.
SN  - 0887-8013
SN  - 1098-2825
ER  -