Quality assurance in biological monitoring of environmental exposure to pollutants: from reference materials to external quality assessment schemes

The presence of chemicals in the environment is a matter of concern in that it poses potential health risks. At present, exposure to toxic chemicals and their biological and biochemical effects can be better estimated by biological monitoring, through the systematic collection of specimens from potentially exposed humans. Biological monitoring of human exposure to environmental pollutants is hampered by the difficulty to assess data reliability. As a consequence, the validity of biological monitoring should depend on the strict implementation of a quality assurance (QA) program, which includes a series of procedures aiming to ensure that laboratory results meet defined standards of quality and are reliable. For the validation and monitoring of methods’ performance, to ensure the trueness of measurements and to warrant the traceability to international standards, reference materials (RMs) and certified reference materials should be used. Internal quality control and external quality assessment (EQA) are part of overall QA and are carried out to verify that analytical errors are compatible with the specific requirements or needs of the user. In particular EQA schemes (EQAS) allow to test independently the analytical performance of participating laboratories. In the last decades, increasing concern has been raised by urban air pollution; lead and benzene, two gasoline components released by motor vehicle exhausts, are known to be toxic to humans. For biological monitoring of lead exposure of the general population, screening campaigns, utilizing lead in blood as a biomarker, have been carried out since the 1970s. Strict strategies were adopted to ensure data comparability, including the preparation of RMs, the organization of EQAS and the cross-exchange and analysis of blood samples between laboratories. Biological monitoring of benzene exposure could be carried out by means of various biomarkers such as benzene in blood and benzene, trans,trans-muconic acid (t,t-MA) and S-phenylmercapturic acid (S-PMA) in urine. At present, few RMs and EQAS are available for these biomarkers. A pilot EQAS for t,t-MA in urine, adopted to assess the reliability of data regarding benzene exposure, has been organized and carried out between 1996 and 1997 in Italy. From the accrued experience, it clearly emerges the importance of strategies designed to guarantee the quality of biological monitoring data. The use of RMs and the participation in EQAS are highly recommended in order to improve the global performance of methods and laboratories involved in biological monitoring.     

Determination of trans,trans‐muconic acid in workers' urine through ultra‐performance liquid chromatography coupled to tandem mass spectrometry

A novel method for the biological monitoring of benzene‐exposed workers has been developed through ultra‐performance liquid chromatography coupled to tandem mass spectrometry. The method uses trans,trans‐muconic acid in urine as the benzene‐exposure biomarker. The method was developed using a triple quadrupole mass spectrometer with enough sensitivity to facilitate diluting and injecting the urine samples directly, rather than performing a solid‐phase extraction procedure as is common in the available protocols. Moreover, compared with a conventional high‐pressure liquid chromatography system, the separation power provided by the ultra‐performance liquid chromatography system allows a 10‐fold reduction in run time. The method was adjusted to a dynamic range of between 198.9 and 4916.7 µg/L to cover the biological exposure index of trans,trans‐muconic acid in urine. Also, the method demonstrated intra‐day and inter‐day precision at 98%, and accuracy within an acceptable range of 101 ± 8%. The method has been used to quantify various types of urine samples, such as workers' urine and inter‐laboratory proficiency tests. Depending on the sample, the quantified levels ranged from less than the limit of quantitation to 3836.7 µg/L. No levels exceeding the calibration range were detected in the urine of workers, and the reported concentrations in urine for the proficiency tests were, as expected, based on known values. Moreover, the new method using sample dilution and faster chromatographic run was more effective, facilitating fast communication of results, as needed, to decision‐makers. Copyright © 2012 John Wiley & Sons, Ltd.     

Human urine certified reference material CZ 6010: creatinine and toluene metabolites (hippuric acid and o-cresol) and a benzene metabolite (phenol)

A reference material for the biological monitoring of occupational exposure to toluene, benzene and phenol was prepared. O-cresol and hippuric acid (metabolites of toluene) are used for the biological monitoring of occupational exposure to toluene. Phenol, a metabolite of benzene, is used for the biological monitoring of exposure to benzene, but phenol can of course also be used as an indicator of exposure to phenol as well. The reference material (RM) used for the determination of these metabolites was prepared by freeze-drying pooled urine samples obtained from healthy persons occupationally exposed to toluene and those taking part in an inhalation experiment. Tests for homogeneity and stability were performed by determining urine concentrations of o-cresol, hippuric acid, creatinine and phenol. To investigate the stability of the RM, the urinary concentrations of o-cresol and phenol were monitored for eighteen months using GC and HPLC, while those of hippuric acid and creatinine were followed for five and six years, respectively, using HPLC. Analysis of variance showed that the concentrations did not change. The certified concentration values (and their uncertainties) of the substances in this reference material (phenol concentration c=6.46±0.58 mg l⁻¹; o-cresol concentration c=1.17±0.15 mg l⁻¹; hippuric acid concentration c=1328±30 mg l⁻¹; creatinine concentration c=0.82±0.10 g l⁻¹) were evaluated via the interactive statistical programme IPECA.     

Simultaneous determination of benzene and toluene in the blood using head-space gas chromatography

A head-space method for the simultaneous determination of benzene and toluene in blood using a gas chromatograph equipped with a photoionization detector was developed. Internal standards for benzene and toluene were fluorobenzene and o-xylene, respectively, and the detection limit was 5 nmol/l for both solvents. This method is sensitive enough for needs of biological monitoring of benzene and toluene in exposed workers. With automation it offers a possibility for routine measurements. An application of the method in monitoring exposed workers in the industry is presented.     

An Evidence-Based Review of Application Devices for Nitric Oxide Concentration Determination from Exhaled Air in the Diagnosis of Inflammation and Treatment Monitoring

The measurement of nitric oxide (NO) in exhaled air is used in diagnostics and monitoring the pathologies not only in the respiratory system but also in the oral cavity. It has shown a huge increase in its level in asthma and diseases of the oral cavity. It seems reasonable to undertake research on the impact of inflammation on the level of NO in exhaled air. The aim of the study is to make an evidence-based review of the application of NO levels in exhaled air in the diagnosis of inflammation and treatment monitoring on the basis of selected measuring devices. Methods and Results: This paper presents an example of the application of NO measurement in exhaled air in individual human systems. Selected measuring devices, their non-invasiveness, and their advantages are described. Discussion: The usefulness of this diagnostic method in pathologies of the oral cavity was noted. Conclusions: Measuring the level of NO in exhaled air seems to be a useful diagnostic method.     

Determination of urinary S-phenylmercapturic acid, a specific metabolite of benzene, by liquid chromatography/single quadrupole mass spectrometry

A high-performance liquid chromatography/single quadrupole mass spectrometry (LC/MS) method is described for the determination of urinary S-phenylmercapturic acid (S-PMA), a specific metabolite of benzene. Urine samples were spiked with [13C6]S-PMA (used as the internal standard) and acidified; then they were purified by solid-phase extraction (SPE) on C18 cartridges. Analyses were conducted on a reversed-phase column by gradient runs with 1% aqueous acetic acid/methanol mixtures at different proportions as the mobile phase. The detector was used in electrospray negative ion mode (ESI-), the ions m/z 238 for S-PMA and 244 for [13C6]S-PMA being recorded simultaneously. The detection limit (for a signal-to-noise ratio = 3) was 0.2 microg/L, thus allowing for the measurement of background excretion of S-PMA in the general population. The use of the internal standard allowed us to obtain good precision (CV% values < 3%) and a linear calibration curve within the range of interest for monitoring occupational exposure to benzene (up to 500 microg/L). The method was applied to assay the metabolite concentration in a group of 299 workers (68 smokers and 231 non-smokers) occupationally exposed to relatively low levels of benzene (environmental concentration = 0.4-220 microg/m3, mean 11.4 microg/m3 and 236 non-exposed subjects (134 smokers and 102 non-smokers). The results clearly showed that smoking must be taken into account for the correct interpretation of the results of S-PMA measurements for the assessment of work-related benzene exposure. When only non-smokers were selected, the mean excretion of S-PMA was significantly higher in workers exposed to benzene (1.2 +/- 0.9 microg/g creatinine) than in the control group (0.7 +/- 0.6 microg/g creatinine) (p < 0.001), thus confirming the role of S-PMA as a biomarker of benzene on a group basis, even for relatively low exposure degrees.     

Real-time monitoring of intravenous hypnotics propofol

A method for the determination of intravenous hypnotics in blood by monitoring of its concentration in exhaled air under clinical conditions is described. The results of propofol quantification in exhaled air are compared with those in blood collected by means of mass spectrometry. The possibility of the on-line noninvasive control of propofol in blood in the course of complex anesthesia using a mass spectrometer with electron ionization is demonstrated.     

Direct measurement of the mercury content of exhaled air: a new approach for determination of the mercury dose received

A new rapid technique is presented for determination of the dose of mercury inhaled; it is based on direct measurement of the concentration of mercury in exhaled air by use of a Zeeman mercury spectrometer RA-915+. It has been demonstrated experimentally that the dose received during short-term exposure to mercury vapor is determined more reliably by this method rather than by conventional techniques based on measurement of the mercury content in blood or urine.     

高效液相色谱法测定尿中苯的代谢物反，反-粘糠酸

建立了高效液相色谱测定职业苯接触者尿中苯的代谢物反,反-粘糠酸(tt-MA)的方法。该方法采用C18柱进行分离,以冰乙酸-四氢呋喃-甲醇-水(体积比为1∶2∶10∶87)为流动相,以香草酸为内标,于264 nm处进行紫外检测。尿样经2 mol/L盐酸酸化后用乙酸乙酯进行萃取。结果表明,所建立的标准曲线在tt-MA的质量浓度为0.10~10.00 mg/L时线性关系良好(r＝0.9999),加标回收率为95.1%~100.5%,日内和日间测定的相对标准偏差分别为4.0%~9.0%和6.2%~8.8%。应用该法测定职业苯接触者56人和非职业苯接触者24人尿中的tt-MA,结果显示职业苯接触者的尿中tt-MA含量明显高于非职业苯接触者,并与接触的苯的浓度呈线性相关(P＜0.01)。该方法灵敏、快速、经济、简便,可用于职业苯接触者的生物监测和毒物动力学研究。     

Selected ion flow tube mass spectrometry for on-line trace gas analysis in biology and medicine

Selected ion flow tube mass spectrometry, (SIFT-MS), is a technique for simultaneous real-time quantification of several trace gases in air and exhaled breath. It relies on chemical ionization of the trace gas molecules in air/breath samples introduced into helium carrier gas, using H(3)O(+), NO(+) and O(2)(+) reagent (precursor ions). Reactions between the precursor ions and the trace gas molecules proceed for an accurately defined time, the precursor and product ions being detected and counted by a downstream mass spectrometer. Absolute concentrations of trace gases in single breath exhalation can be determined by SIFT-MS down to parts-per-billion (ppb) levels, obviating sample collection into bags or onto traps. Calibration using chemical standards is not required, as the concentrations are calculated using the known reaction rate constants and measured flow rates and pressures. SIFT-MS has been used for many pilot investigations in several areas of research, especially as a non-invasive breath analysis tool to investigate physiological processes in humans and animals, for clinical diagnosis and for therapeutic monitoring. Examples of the results obtained from several such studies are outlined to demonstrate the potential of SIFT-MS for trace gas analysis of air, exhaled breath and the headspace above liquids.     

Application of solid-phase microextraction and gas chromatography-mass spectrometry to the determination of volatile organic compounds in end-exhaled breath samples

Analysis of exhaled air is of particular interest as an indicator of health as well as a tool for the diagnosis of diseases. It is also a very attractive procedure for the biological control of the exposition to hazardous solvents. This kind of analysis presents numerous advantages over other methods, the most important being that it is not an invasive procedure and, therefore, it is well accepted and can be applied to a wide range of compounds. Furthermore, the analysis is simplified since the matrix is less complex that in the case of blood or urine. In spite of these obvious advantages and the good results obtained, analysis of exhaled air is not in daily use, probably due to the fact that there are no normalized systems of sampling, thus making the interpretation of the results difficult. In this paper, a method for the determination of tetrachloroethylene in exhaled air using solid-phase microextraction is presented. This method, which can be applied to other volatile organic compounds, was developed with special emphasis of end-exhaled breath sampling. The sample is collected in a glass tube whose ends are closed once the exhalation is finished. The tube has an orifice sealed with a septum through which the fiber is inserted. Then, the fiber is desorbed in the injector of a gas chromatograph and the analysis is accomplished using mass spectrometry for the identification and quantification of the components. The proposed system avoids the need of complex sampling equipment and allows analysis of the alveolar fraction. Additionally, the system is economical and easy to handle, thus facilitating the development of normalized methods and its routine use in field studies.     

Assay of urinary alpha-fluoro-beta-alanine by gas chromatography-mass spectrometry for the biological monitoring of occupational exposure to 5-fluorouracil in oncology nurses and pharmacy technicians

The validation of an analytical method for the measurement of the unnatural amino acid alpha-fluoro-beta-alanine (AFBA), the main metabolite of the antineoplastic drug 5-fluorouracil (5FU), in urine for the biological monitoring of the exposure of hospital workers to the drug when preparing the therapeutical doses and administering to cancer patients is described. The method employed a two-step extractive derivatization of the analyte from urine to the N-trifluoroacety-n-butyl ester derivative and detection by selected-ion monitoring gas chromatography-mass spectrometry of structurally specific fragments. The limit of detection was 20 ng/mL with quantification accuracy better than +/-20% and precision (CV%) better than +/-20% in the range 0.020-10 microg/mL. Norleucine was used as the internal standard and the sample-to-sample analysis time was less than 15 min. The validated method has been applied to the biological monitoring of some hospital workers potentially exposed to 5FU and to matched control subjects. On a total number of 65 analyzed urine samples from control and exposed subjects, only three, obtained from exposed subjects, were found to be positive, with values of 20, 30 and 1150 ng/mL, respectively.     

Comparison of the absolute calibration method with the method of standard addition for the determination of halothane in blood by gas chromatographic headspace analysis

As long-term exposure to exhaled halothane can be a cause of hepatitis and/or damage to the liver, the determination of halothane in blood is important in clinical practice. Gas chromatographic headspace analysis appears to be the most successful method. In the present study, two methods of quantitative evaluation of the analysis were compared by statistical treatment and direct comparison. The absolute calibration method was found to be unsuitable since it yields entirely unreliable results. This is due to different contents of lipoid and other components in the blood of the normal population, and this influences the vapour phase concentration of halothane and results in different values for the slopes of calibration curves for different blood samples. The standard addition method gives reliable results.     

Calibration procedure for solid phase microextraction-gas chromatographic analysis of organic vapours in air

A calibration procedure for solid phase microextraction-gas chromatographic (SPME-GC) analysis of organic vapours in air was described in which GC detector (MS in this case) signal is directly related to concentration of analytes of interest sampled by SPME. Gaseous standard mixtures used for the calibration were generated by means of a home-made permeation-type apparatus described elsewhere, W. Janicki et al., Chem. Anal., 38 (1993) 423 and modified to permit easy sampling of analytes on an SPME fibre. To establish sampling parameters, times for equilibrium partitioning of five selected organic compounds (carbon tetrachloride, toluene, chlorobenzene, p-xylene, n-decane) between gaseous mixtures and the fibre (fused silica fibre coated with 100 mum polydimethylsiloxane) were determined. For 10 min sampling time, the detector response and hence amount sampled on the fibre were linear functions of analytes concentration in a gaseous sample.     

Exhaled breath condensate as a biomonitor for metal exposure: a new analytical challenge

The study of exhaled breath condensate (EBC) obtained by cooling exhaled air under conditions of spontaneous breathing is considered one of the areas with higher interest in respiratory health research. The use of EBC for elemental determination in occupational exposure requires a standard methodological procedure to implement its practice in occupational studies. EBC is an inhomogeneous sample with organic and particulate matter in suspension, which may hamper analytical results reliability. Total reflection X-ray fluorescence and inductive coupled-plasma mass spectrometry (ICP-MS) techniques were chosen as both are multielemental, require small sample volumes and have appropriate detection limits. Estimation of the overall uncertainty in both techniques was carried out using a pool of EBC collected from a group of workers of a lead processing industry to perform precision and trueness studies for K, Mn, Cu, Cd, Sb and Pb. Precision was estimated in terms of repeatability using the native EBC sample pool and trueness in terms of recovery obtained from spiking aliquots of the EBC pool with K, Mn, Cu, Cd, Sb and Pb at different concentrations. Recovery was the most significant contribution to total uncertainty. The overall uncertainties obtained for ICP-MS enabled to discriminate between groups of individuals exposed to different levels of contaminants. Therefore EBC proved to be useful in human biomonitoring.     

Polymeric nanofilm-coated optical fibre sensor for speciation of aromatic compounds

An optical fibre sensor has been shown to be suitable for monitoring of benzene, toluene and o-xylene (BTX) with both high selectivity and sensitivity. The sensing principle underlying this experimental device is based on the changes of the reflected optical power when BTX vapours are present in the analytical tube containing an optical fibre coated with a thin film of poly[methyl(3, 3, 3-trifluoropropyl)siloxane]. The interaction of organic vapour with the sensitive surface promotes a variation of the light power, proportional to the amount of adsorbed BTX vapour. A set of experiments concerning different operational conditions was performed in order to promote a higher analytical performance and the newly developed BTX sensor showed higher sensitivity and shorter analytical time than a method based on gas chromatography–flame ionisation detector. Furthermore, the proposed sensor also provides the basis for an inexpensive analytical technique with adequate specificity for measurements of BTX at trace levels with appropriate reversibility, repeatability, and reproducibility. Finally, the analytical performance of the developed sensor was also evaluated and found adequate for industrial air samples.     

Estimation of exposure levels by measurements and models

Summary Results from environmental and biological monitoring programs are abundant, but it is a question to what extent such data can be used for exposure assessments. The quality of such data depends not only on sampling and analytical errors, but also, and probably more, on the sampling strategy used. Therefore, uncritically use of such results can be biased and associated with large variations. The size of bias between two studies carried out in the same industry was found to be a factor of 5–7. Samples that are not representative of the exposed population studied are misleading. An estimation of exposure to cobalt in the porcelain industry illustrates the distinction between biological measurement data and air cobalt measurement data done on selected individuals. Following improvement of the working environment during the period 1983–1990, the change of cobalt concentration in urine indicates a reduction of cobalt exposure with a factor of 10, but air monitoring data do not verify that figure. Furthermore, results must always be interpreted with caution, when used beyond the purpose for what they were originally made. Great care should be taken to secure that data are representative and a quality assurance-quality control program should be used to ensure data quality.     

Direct, rapid quantitative analyses of BVOCs using SIFT-MS and PTR-MS obviating sample collection

The purpose of this short review is to describe the origins and the principles of operation of selected-ion flow-tube mass spectrometry (SIFT-MS) and proton-transfer-reaction mass spectrometry (PTR-MS), and their application to the analysis of biogenic volatile organic compounds (BVOCs) in ambient air, the humid air (headspace) above biological samples, and other samples. We briefly review the ion chemistry that underpins these analytical methods, which allows accurate analyses. We pay attention to the inherently uncomplicated sampling methodologies that allow on-line, real-time analyses, obviating sample collection into bags or onto traps, which can compromise samples.Whilst these techniques have been applied successfully to the analysis of a wide variety of media, we give just a few examples of data, including for the analysis of BVOCs that are present in tropospheric air and those emitted by plants, in exhaled breath and in the headspace above cell and bacterial cultures (which assist clinical diagnosis and therapeutic monitoring), and the products of combustion. The very wide dynamic ranges of real-time analyses of BVOCs in air achieved by SIFT-MS and PTR-MS - from sub-ppbv to tens of ppmv - ensure that these analytical methods will be applied to many other media, especially when combined with gas-chromatography methods, as recently trialed.     

Development and validation of an isotope-dilution electrospray ionization tandem mass spectrometry method with an on-line sample clean-up device for the quantitative analysis of the benzene exposure biomarker S-phenylmercapturic acid in human urine

An isotope-dilution electrospray ionization tandem mass spectrometry (ESI-MS/MS) method with an on-line sample clean-up device, for the quantitative analysis of human urine for the benzene exposure biomarker S-phenylmercapturic acid (SPMA), was developed and validated. The sample clean-up system was constructed from an autosampler, a reversed-phase C18 trap cartridge, a two-position switching valve, and controlling computer software and hardware. The sample clean-up system was interfaced via 1/20 splitting to the ESI source of a triple-quadrupole mass spectrometer using negative ion mode and multiple reaction monitoring for SPMA and the isotope-labeled internal standard. A strategy was adopted to acquire pooled blank urine matrix and quality control samples spiked with standards. Validated procedures and data on method specificity, detection limits, standard curves, precision and recovery, sample storage stability, and inter-laboratory comparison are presented. The analytical system was fully automated. No tedious manual sample clean-up procedures are required. With the selectivity and the sensitivity provided by ESI-MS/MS detection, the analytical system can be used for high-throughput and accurate determination of SPMA levels in human urine samples, as a biomarker for environmental as well as occupational benzene exposure.