Reference range and short- and long-term biological variation of interleukin (IL)-6, IL-17A and tissue necrosis factor-alpha using high sensitivity assays

• Reference range for IL-6, TNF, and IL-17A were determined in blood of healthy subjects. • Biological variation for IL-17A not previously reported was similar to IL-6 and TNF. • IL-17A is an emerging biomarker for cardiovascular disease. Interleukin (IL)-6, and tissue necrosis factor alpha (TNF-α) are established biomarkers for clinical practice and use in clinical trials of patients with cardiovascular disease. IL-17A may be an emerging marker for atherosclerosis disease progression. We measured IL-6, TNF-α, and IL-17A using a high sensitivity immunoassay (Erenna, Singulex, Inc.) to determine the reference range and to calculate the weekly (25 subjects over 6 weeks) and monthly (17 subjects over 9 months) biological variation (BV) from apparently healthy subjects and those attending a cardiovascular disease clinic. As a validation for the experimental and statistical approach taken, the weekly BV for high sensitivity C-reactive protein was also determined and result compared to previous reports. The upper 95th percentile reference limit for IL-6, TNF-α, and IL17-A was 4.45, 2.53, and 1.93 pg/mL, respectively. The intra-individual variability ranged from 21% to 57% and the inter-individual variation ranged from 22% to 53%. The corresponding index of individuality was 0.65–1.6 and reference change values from 63% to 161%. The BV for IL-6 and TNF-α are similar to previous reports, documenting their diagnostic utility in clinical practice. Up until now, the biological variation of IL-17A and upper reference limit has not been previously reported, thereby limiting the use of this marker in clinical trials.