Detection of proteins released in the bloodstream from tissues damaged by disease can promote early detection of pathological conditions, differential diagnostics, and follow-up of therapy. Despite these prospects and a plethora of candidate biomarkers, efforts in recent years to establish new protein diagnostic assays have met with limited success. One important limiting factor has been the challenge of detecting proteins present at trace levels in complex bodily fluids. To achieve robust, sensitive, and specific detection, we have developed a microparticlebased solid-phase proximity ligation assay, dependent on simultaneous recognition of target proteins by three antibody molecules for added specificity. After capture on a microparticle, solid-phase pairs of proximity probes are added followed by washes, enabling detection and identification of rare protein molecules in blood while consuming small amounts of sample. We demonstrate that single polyclonal antibody preparations raised against target proteins of interest can be readily used to establish assays where detection depends on target recognition by three individual antibody molecules, recognizing separate epitopes. The assay was compared with state-ofthe-art sandwich ELISAs for detection of vascular endothelial growth factor, interleukin-8 and interleukin-6, and it was found to be superior both with regard to dynamic range and minimal numbers of molecules detected. Furthermore, the assays exhibited excellent performance in undiluted plasma and serum as well as in whole blood, producing comparable results for nine different antigens. We thus show that solid-phase proximity ligation assay is suitable for validation of a variety of protein biomarkers over broad dynamic ranges in clinical samples. Molecular & Cellular Proteomics 9:327-335, 2010.Analyses of the plasma proteome, its protein content, their modifications, and interactions, hold great promise to improve detection, classification, and prognostication of pathological conditions such as cancer (1). The attraction of serum or plasma biomarkers lies in their potential to reveal disease processes throughout the body and to guide selection of therapy and follow-up using minimally invasive blood sampling.This optimism is tempered by the molecular complexity of plasma and the fact that the abundance of known plasma proteins varies over at least 12 orders of magnitude (1), posing great challenges for immunoassays used to investigate the plasma proteome. Thus, new assay formats are needed that can offer improved sensitivity and specificity over a broad dynamic range with good precision to assess new protein biomarkers for analysis in plasma, serum, or whole blood.The proximity ligation assay (PLA), 1 first described by Fredriksson et al. (2) in 2002, is an immunoassay for detection of protein molecules via DNA ligation and amplification, offering high specificity and sensitivity. In PLA, pairs of affinity probes directed against the same target molecule are modified by attaching short single-stranded DNA m...