We measured ATX levels by a specific two-site enzyme immunoassay using the commercial automated immunoassay analyzer AIA-system (Tosoh Co., Tokyo, Japan) for serum samples obtained before the start of treatment, at 4 weeks after the start of treatment, and at 24 weeks after treatment completion. The AIA-system includes automated 10-microliter specimen dispensation, incubation of the reaction cup, a bound/free washing procedure, 4-methylumbelliferyl phosphate substrate dispensation, fluorometric detection, and a result report. The antigen-antibody reaction time is 10 min and the first result is reported within 20 min. The throughput of the AIA-2000 system is 200 samples/h [27 (link)]. The assay was conducted according to the optimized protocols used in previous studies [22 (link), 23 (link)].
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