Salivary Cortisol: Expanded Range High Sensitivity
Salivary Cortisol: Expanded Range High Sensitivity
Salivary Cortisol: Expanded Range High Sensitivity
High Sensitivity
SALIVARY CORTISOL
ENZYME IMMUNOASSAY KIT
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TABLE OF CONTENTS
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Intended Use
Please read the complete kit insert before performing this assay. Failure to follow
kit procedure and recommendations for saliva collection and sample handling may
result in unreliable values.
For further information about this kit, its application, or the procedures in this insert, please
contact the technical service team at Salimetrics or your local sales representative.
Introduction
Cortisol (hydrocortisone, Compound F) is the major glucocorticoid produced in the adrenal
cortex (1). Cortisol production has a circadian rhythm, (2,3) with levels peaking in the early
morning and dropping to lowest values at night (4,5). Levels rise independently of circadian
rhythm in response to stress (6).
In blood, only about 5-10% of Cortisol is in its unbound or biologically active form. The
remaining Cortisol is bound to serum proteins (7). Unbound serum Cortisol enters saliva via
intracellular mechanisms; in saliva, the majority of Cortisol remains unbound to protein.
Salivary Cortisol levels are unaffected by salivary flow rate and are relatively resistant to
degradation from enzymes or freeze-thaw cycles (8,9). Studies consistently report high
correlations between serum and salivary Cortisol, indicating that salivary Cortisol levels reliably
estimate serum Cortisol levels (10-12).
(Internal Salimetrics Data, n=26. Time of Cortisol peak will vary in individuals relative to their normal wake-up time.)
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Test Principle
This is a competitive immunoassay kit. Cortisol in standards and samples compete with
Cortisol conjugated to horseradish peroxidase for the antibody binding sites on a microtitre
plate. After incubation, unbound components are washed away. Bound Cortisol Enzyme
Conjugate is measured by the reaction of the horseradish peroxidase enzyme to the substrate
tetramethylbenzidine (TMB). This reaction produces a blue color. A yellow color is formed after
stopping the reaction with an acidic solution. The optical density is read on a standard plate
reader at 450 nm. The amount of Cortisol Enzyme Conjugate detected is inversely proportional
to the amount of Cortisol present in the sample (13).
Safety Precautions
Read Safety Data Sheets before handling reagents.
Hazardous Ingredients
Liquid Stop Solution is caustic; use with care. We recommend the procedures listed below for
all kit reagents.
Handling
Follow good laboratory practices when handling kit reagents. Laboratory coats, gloves, and
safety goggles are recommended. Wipe up spills using appropriate absorbent materials while
wearing protective clothing. Follow local regulations for disposal.
In case of contact, immediately wash skin or flush eyes with water for 15 minutes. Remove
contaminated clothing. If inhaled, remove individual to fresh air. If individual experiences
difficulty breathing call a physician.
The above information is believed to be accurate but is not all-inclusive. This information
should be used only as a guide. Salimetrics will not be liable for accidents or damage resulting
from misuse of product.
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General Kit Use Advice
• This kit uses break-apart microtitre strips. You may run less than a full plate. Unused
wells must be stored at 2-8°C in the foil pouch with desiccant and used in the frame
provided.
• Avoid microbial contamination of opened reagents. Salimetrics recommends using
opened reagents within one month. Store all reagents at 2-8°C.
• The quantity of reagent provided with a single kit is sufficient for three partial runs. The
volumes of wash buffer and enzyme conjugate prepared for assays using less than a
full plate should be scaled down accordingly, keeping the same dilution ratio.
• Do not mix components from different lots of kits.
• To ensure highest quality assay results, pipetting of samples and reagents must be
done as quickly as possible (without interruption) across the plate. Ideally, the process
should be completed within 20 minutes or less.
• When using a multichannel pipette to add reagents, always follow the same sequence
when adding all reagents so that the incubation time is the same for all wells.
• When running multiple plates, or multiple sets of strips, a standard curve must be run
with each individual plate and/or set of strips.
• The temperature of the laboratory may affect assays. Salimetrics’ kits have been
validated at 68-74°F (20-23.3°C). Higher or lower temperatures may affect OD values.
• Routine calibration of pipettes and other equipment is critical for the best possible assay
performance.
• When mixing plates during assay procedures, avoid speeds that spill the contents of the
wells.
Storage
All unopened components of this kit are stable at 2-8°C until the kit’s expiration date.
pH Indicator
Cortisol values from samples with a pH < 3.5 or > 9.0 may be inaccurate. A pH indicator in
the Assay Diluent alerts the user to samples with high or low pH values. Upon addition of the
Assay Diluent, acidic samples will turn yellow and alkaline samples will turn purple. Dark yellow
or purple wells indicate that a pH value for that sample should be obtained using pH strips.
Samples with a pH < 3.5 or > 9.0 should be recollected (14).
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Specimen Collection
Avoid sample collection within 60 minutes after eating a major meal or within 12 hours after
consuming alcohol. Acidic or high sugar foods can compromise assay performance by lowering
sample pH and influencing bacterial growth. To minimize these factors, rinse mouth
thoroughly with water 10 minutes before sample is collected.
Collect whole saliva by unstimulated passive drool. Donors may tilt the head forward, allowing
the saliva to pool on the floor of the mouth, then pass the saliva through the SalivaBio
Collection Aid (SCA) into a polypropylene vial. Collection protocols/methods are available
online at www.salimetrics.com or upon request.
Samples visibly contaminated with blood should be recollected. Samples may be screened for
possible blood contamination (15,16) using our Blood Contamination EIA Kit (Item Nos. 1-
1302/1-1302-5). Do not use dipsticks, which result in false positive values due to salivary
enzymes.
It is important to record the time and date of specimen collection when samples are obtained
due to the diurnal variation in Cortisol levels.
On day of assay, thaw the saliva samples completely, vortex, and centrifuge at 1500 x g for 15
minutes. Freezing saliva samples will precipitate mucins. Centrifuging removes mucins and
other particulate matter which may interfere with antibody binding and affect results. Samples
should be at room temperature before adding to assay plate. Pipette clear sample into
appropriate wells. Re-freeze saliva samples as soon as possible after adding to the assay plate.
Re-centrifuge saliva samples each time that they are thawed. Avoid multiple freeze-thaw
cycles.
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Materials Supplied with Single Kit
Item Quantity/Size
Microtitre Plate
1 1/96 well
Coated with monoclonal anti-Cortisol antibodies.
Cortisol Standard
In a saliva-like matrix. Ready to use, traceable to NIST
2 standard: 3.0, 1.0, 0.333, 0.111, 0.037, 0.012 μg/dL 6 vials / 500 μL each
(82.77, 27.59, 9.19, 3.06, 1.02, 0.33 nmol/L).
Contains: Cortisol, buffer, preservative.
Cortisol Controls
3 High, Low, in a saliva-like matrix. Ready to use. 2 vials / 500 μL each
Contain: Cortisol, buffer, preservative.
Assay Diluent
5 1 bottle / 60 mL
Contains: phosphate buffer, pH indicator, preservative.
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Materials Needed But Not Supplied
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Reagent Preparation
• Bring all reagents to room temperature and mix before use. A minimum of 1.5 hours is
recommended for the 24 mL of Assay Diluent used in Step 5 (conjugate dilution) to
come to room temperature.
• Bring Microtitre Plate to room temperature before use. It is important to keep the
foil pouch with the plate strips closed until warmed to room temperature, as
humidity may have an effect on the coated wells.
• Prepare 1X wash buffer by diluting Wash Buffer Concentrate (10X) 10-fold with room-
temperature deionized water (100 mL of Wash Buffer Concentrate (10X) to 900 mL of
deionized H2O). Dilute only enough for current day’s use and discard any
leftover reagent. (If precipitate has formed in the concentrated wash buffer, it may
be heated to 40°C for 15 minutes. Cool to room temperature before use in assay.)
Procedure
Step 1: Read and prepare reagents according to the Reagent Preparation section before
beginning assay. Determine your plate layout. Here is a suggested layout. (Standards,
controls, and saliva samples should be assayed in duplicate.)
1 2 3 4 5 6 7 8 9 10 11 12
A 3.000 Std 3.000 Std Ctrl-H Ctrl-H
*NSB = Non-specific binding wells. These may serve as blanks. Use is optional.
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Step 2: Keep the desired number of strips in the strip holder and place the remaining strips
back in the foil pouch. If you choose to place non-specific binding wells in H-1, 2, remove
strips 1 and 2 from the strip holder and break off the bottom wells. Place the strips back into
the strip holder leaving H-1, 2 blank. Break off 2 NSB wells from the strip of NSB wells
included in the foil pouch. Place in H-1, 2. Alternatively, NSBs may be placed wherever you
choose on the plate. Reseal the foil pouch with unused wells and desiccant. Store at 2-8°C.
Cautions: 1. Extra NSB wells should not be used for determination of standards,
controls, or unknowns.
2. Do not insert wells from one plate into a different plate
Step 3: Pipette 24 mL of Assay Diluent into the disposable tube. (Scale down proportionally if
using less than the entire plate.) Set aside for Step 5.
Step 4:
• Pipette 25 μL of standards, controls, and saliva samples into appropriate wells.
• Pipette 25 μL of Assay Diluent into 2 wells to serve as the zero.
• Pipette 25 μL of Assay Diluent into each NSB well.
Step 5: Dilute the Enzyme Conjugate 1:1600 by adding 15 μL of the conjugate to the 24 mL
tube of Assay Diluent. (Scale down proportionally if not using the entire plate.) Conjugate tube
may be centrifuged for a few minutes to bring the liquid down to the tube bottom.
Immediately mix the diluted conjugate solution and add 200 μL to each well using a
multichannel pipette.
Step 6: Mix plate on a plate rotator for 5 minutes at 500 rpm and incubate at room
temperature for a total of 1 hour.
Step 7: Wash the plate 4 times with 1X wash buffer. A plate washer is recommended.
However, washing may be done by gently squirting wash buffer into each well with a squirt
bottle, or by pipetting 300 μL of wash buffer into each well and then discarding the liquid over
a sink. After each wash, the plate should be thoroughly blotted on paper towels before turning
upright. If using a plate washer, blotting is still recommended after the last wash.
Step 8: Add 200 μL of TMB Substrate Solution to each well with a multichannel pipette.
Step 9: Mix on a plate rotator for 5 minutes at 500 rpm and incubate the plate in the dark
(covered) at room temperature for an additional 25 minutes.
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Step 11:
• Mix on a plate rotator for 3 minutes at 500 rpm. If green color remains, continue
mixing until green color turns to yellow. Be sure all wells have turned yellow.
Caution: Spillage may occur if mixing speed exceeds 600 rpm.
• Wipe off bottom of plate with a water-moistened, lint-free cloth and wipe dry.
• Read in a plate reader at 450 nm. Read plate within 10 minutes of adding Stop
Solution. (For best results, a secondary filter correction at 490 to 492 nm is
recommended.)
Quality Control
The Salimetrics’ High and Low Cortisol Controls should be run with each assay. The control
ranges established at Salimetrics are to be used as a guide. Each laboratory should establish
its own range. Variations between laboratories may be caused by differences in techniques
and instrumentation.
Calculations
1. Compute the average optical density (OD) for all duplicate wells.
2. Subtract the average OD for the NSB wells (if used) from the OD of the zero,
standards, controls, and saliva samples.
3. Calculate the percent bound (B/Bo) for each standard, control, and saliva sample by
dividing the OD of each well (B) by the average OD for the zero (Bo). (The zero is
not a point on the standard curve.)
4. Determine the concentrations of the controls and saliva samples by interpolation
using data reduction software. We recommend using a 4-parameter non-linear
regression curve fit.
5. Samples with Cortisol values greater than 3.0 μg/dL (82.77 nmol/L) should be
diluted with Assay Diluent and rerun for accurate results. If a dilution of the sample
is used, multiply the assay results by the dilution factor.
A new Standard Curve must be run with each full or partial plate.
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Typical Results
The results shown below are for illustration only and should not be used to calculate results
from another assay.
Average Cortisol
Well Standard B B/Bo
OD (μg/dL)
A1,A2 S1 0.094 0.071 0.048 3.000
1.0
0.9
0.8
0.7
0.6
B / Bo
0.5
0.4
0.3
0.2
0.1
0.0
0.012 0.037 0.111 0.333 1.000 3.000
Cortisol (µg/dL)
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Limitations
• Samples with Cortisol values greater than 3.0 μg/dL (82.77 nmol/L) should be diluted
with Assay Diluent and rerun for accurate results. To obtain the final Cortisol
concentration, multiply the concentration of the diluted sample by the dilution factor.
• A pH value should be obtained on samples that appear yellow or purple after the
diluted conjugate solution is added and the plate is mixed (Step 6). Samples with pH
values < 3.5 or > 9.0 should be recollected.
• See “Specimen Collection” recommendations to ensure proper collection of saliva
specimens and to avoid interfering substances.
• Samples collected with sodium azide are unsuitable for this assay.
• Any quantitative results indicating abnormal Cortisol levels should be followed by
additional testing and evaluation.
Overall Range
Group Number
(μg/dL)
23:00 hrs.
Group Number
(μg/dL)
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AM Range PM Range
Group Number
(μg/dL) (μg/dL)
*To be used as a guide only. Each laboratory should establish its own range.
ND = None detected
Expected ranges for neonates to 5.5 years were derived using the Salimetrics Salivary Cortisol
Immunoassay Kit.
Expected ranges for 8 to 18 years were reported from an unpublished manuscript, Pennsylvania
State University’s Behavioral Endocrinology Laboratory. Adult ranges were obtained from published
literature (7).
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HS Salivary Cortisol EIA Kit Performance Characteristics
Precision
The intra-assay precision was determined from the mean of 20 replicates each.
1 20 2.07 0.08 4
2 20 1.14 0.05 4
3 20 0.42 0.01 3
4 20 0.16 0.01 5
5 20 0.06 0.00 7
The inter-assay precision was determined from the mean of average duplicates for 20 separate
runs.
1 20 1.99 0.05 3
2 20 1.16 0.05 4
3 20 0.43 0.01 3
4 20 0.18 0.01 9
5 20 0.06 0.01 11
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Recovery
Five saliva samples containing different levels of an endogenous Cortisol were spiked with
known quantities of Cortisol and assayed.
Sensitivity
Analytical Sensitivity
The lower limit of sensitivity was determined by interpolating the mean optical density minus 2
SDs of 10 sets of duplicates at the 0 μg/dL level. The minimal concentration of Cortisol that
can be distinguished from 0 is 0.007 μg/dL.
Functional Sensitivity
The functional sensitivity was determined by assaying 60 saliva samples at a concentration
level resulting in a CV of approximately 20%. The functional sensitivity of the salivary Cortisol
ELISA is 0.018 μg/dL.
The correlation between saliva and serum was highly significant, r (47) = 0.91, p < 0.0001.
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Sample Dilution Recovery
Four saliva samples were diluted with Assay Diluent and assayed.
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Linearity of Assay
Samples Avg
Saliva Expected Recovery
Observed
Sample (μg/dL) (%)
Low High (μg/dL)
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Antibody Specificity
% Cross-reactivity in
Spiked Concentration
Compound HS Salivary Cortisol
(ng/mL)
EIA
Prednisone 1000 ND
17α-Hydroxyprogesterone 1000 ND
17β-Estradiol 10 ND
DHEA 10,000 ND
Transferrin 66,000 ND
Aldosterone 10,000 ND
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References
1. Carrasco, G.A., & Van de Kar, L.D. (2003). Neuroendocrine pharmacology of stress. Eur J Pharmacol,
463(1-3), 235-72.
2. Dickmeis, T. (2009). Glucocorticoids and the circadian clock. J Endocrinol, 200(1), 3-22.
3. Dorn, L.D., Lucke, J.F., Loucks, T.L., & Berga, S.L. (2007). Salivary cortisol reflects serum cortisol:
Analysis of circadian profiles. Ann Clin Biochem, 44(pt3), 281-84.
4. Hucklebridge, F., Hussain, T., Evans, P., & Clow, A. (2005). The diurnal patterns of the adrenal steroids
cortisol and dehydroepiandrosterone (DHEA) in relation to awakening. Psychoneuroendocrinology,
30(1), 51-57.
5. Knutsson, U., Dahlgren, J., Marcus, C., Rosberg, S., Brönnegård, M., Stierna, P., & Albertsson-Wikland,
K. (1997). Circadian cortisol rhythms in healthy boys and girls: Relationship with age, growth, body
composition, and pubertal development. J Clin Endocrinol Metab, 82(2), 536-40.
6. Miller, G.E., Chen, E., & Zhou, E.S. (2007). If it goes up, must it come down? Chronic stress and the
hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull, 133(1), 25-45.
7. Aardal, E., & Holm, A. (1995). Cortisol in saliva – Reference ranges in relation to cortisol in serum. Eur J
Clin Chem Clin Biochem, 33(12), 927-32.
8. Vining, R.F., & McGinley, R.A. (1987). The measurement of hormones in saliva: Possibilities and pitfalls.
J Steroid Biochem, 27(1-3), 81-94.
9. Garde, A.H., & Hansen, A.M. (2005). Long-term stability of salivary cortisol. Scand J Clin Lab Invest,
65(5), 433-6.
10. Daniel, M., Moore, D.S., Decker, S., Belton, L., DeVellis, B., Doolen, A., & Campbell, M.K. (2006).
Associations among education, cortisol rhythm, and BMI in blue-collar women. Obesity, 14(2), 327-35.
11. Eatough, E.M., Shirtcliff, E.A., Hanson, J.L., & Pollak, S.D. (2009). Hormonal reactivity to MRI scanning
in adolescents. Psychoneuroendocrinology, 34(8), 1242-46.
12. Dorn, L.D., Kolko, D.J., Susman, E.J., Huang, B., Stein, H., Music, E., & Bukstein, O.G. (2009). Salivary
gonadal and adrenal hormone differences in boys and girls with and without disruptive behavior
disorders: Contextual variants. Biol Psychol, 81(1), 31-39.
13. Chard, T. (1990). An introduction to radioimmunoassay and related techniques (4th ed.). Amsterdam:
Elsevier.
14. Schwartz, E.B., Granger, D.A., Susman, E.J., Gunnar, M.R., & Laird, B. (1998). Assessing salivary cortisol
in studies of child development. Child Dev, 69(6), 1503-13.
15. Kivlighan, K.T., Granger, D.A., Schwartz, E.B., Nelson, V., & Curran, M. (2004). Quantifying blood
leakage into the oral mucosa and its effects on the measurement of cortisol, dehydroepiandrosterone,
and testosterone in saliva. Horm Behav, 46(1), 39-46.
16. Schwartz, E., & Granger, D.A. (2004). Transferrin enzyme immunoassay for quantitative monitoring of
blood contamination in saliva. Clin Chem, 50(3), 654-56.
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Seller’s Limited Warranty
“Seller warrants that all goods sold hereunder will be free from defects in material and
workmanship. Upon prompt notice by Buyer of any claimed defect, which notice must be sent
within thirty (30) days from date such defect is first discovered and within three months from
the date of shipment, Seller shall, at its option, either repair or replace the product that is
proved to Seller’s satisfaction to be defective. All claims should be submitted in written form.
This warranty does not cover any damage due to accident, misuse, negligence, or abnormal
use. Liability, in all cases, will be limited to the purchased cost of the kit.
It is expressly agreed that this limited warranty shall be in lieu of all warranties of
fitness and in lieu of the warranty of merchantability. Seller shall not be liable for
any incidental or consequential damages that arise out of the installation, use or
operation of Seller’s product or out of the breach of any express or implied
warranties.”
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