Diagnosis of congenital adrenal hyperplasia by rapid determination of 17alpha-hydroxyprogesterone in dried blood spots by gas chromatography/mass spectrometry following microwave-assisted silylation

17alpha-Hydroxyprogesterone (17OHP) is considered to be the biomarker of congential adrenal hyperplasia (CAH). Screening for CAH in newborns by measuring levels of the biomarker of 17OHP has become routine. In the work, a rapid, simple and sensitive technique was developed for the diagnosis of neonatal CAH by the quantitative analysis of 17OHP in neonatal blood spots. The technique was based on microwave-assisted silylation (MAS) followed by gas chromatography/mass spectrometry (GC/MS). In the method, fast derivatization of 17OHP with N,O-bis(trimethylsilyl)trifluoroacetamide was performed by using microwave irradiation, and the trimethylsilyl derivative thus formed was analyzed by GC/MS. The results of the experiment indicate that MAS followed by GC/MS analysis is a rapid, simple and sensitive method for the determination of 17OHP in blood samples. The proposed technique has been shown to have potential as a powerful tool for the rapid diagnosis of neonatal CAH.     

Analysis of 21-deoxycortisol, a marker of congenital adrenal hyperplasia, in blood by atmospheric pressure chemical ionization and electrospray ionization using multiple reaction monitoring

Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder mainly caused by 21-hydroxylase deficit (21-OHD). Deletions or mutations of the CYP21 gene induce the impairment of glucocorticoid and mineralcorticoid synthesis. 17-Hydroxyprogesterone (17-OHP) is the hormonal marker in patients, but not in the heterozygous subjects. Excess 17-OHP is hydroxylated into 21-deoxycortisol (21-DF), and therefore 21-DF can be used as a specific marker for diagnosis of heterozygous individuals. We report an analytical method for analysis of 21-DF in blood samples using electrospray (ESI) and atmospheric pressure chemical ionization (APCI), showing that ESI is very sensitive for the analysis of this marker molecule. The multiple reaction monitoring (MRM) approach was used to increase the specificity and the sensitivity of the method.     

Comparison of CID versus ETD‐based MS/MS fragmentation for the analysis of doubly derivatized steroids

Electrospray ionization coupled with collision‐induced dissociation (CID) and tandem mass spectrometry (MS/MS) is a commonly used technique to analyze the chemical composition of steroids. However, steroids are structurally similar compounds, making it difficult to interpret their product‐ion spectra. Electron transfer dissociation (ETD), a relatively new technique for protein and peptide fragmentation, has been shown to provide more detailed structural information. In this study, we compared the ability of CID with that of ETD to differentiate between eight 3,20‐dioxosteroids that had been derivatizated with a quaternary ammonium salt, Girard reagent P (GirP), at room temperature or after exposure to microwave irradiation to generate doubly charged ions. We found that the derivatization of steroid with GirP hydrazine occurred in less than 10 min when the reaction was carried out in the presence of microwave irradiation compared to 30 min when the reaction was carried out at room temperature. According to the MS/MS spectra, CID provided rich, structurally informative ions; however, the spectra were complex, thereby complicating the peak assignment. In contrast, ETD generated simpler spectra, making it easier to recognize individual peaks. Remarkably, both CID and ETD were allowed to differentiate of steroid isomers, 17α‐hydroxyprogesterone (17OHP) and deoxycorticosterone (DOC), but the signature ions obtained from CID were less intense than those generated by ETD, which generated much clearer spectra. These results indicate that ETD in conjunction with CID can provide more structural information for precise characterization of steroids. Copyright © 2013 John Wiley & Sons, Ltd.     

Reversed-phase high-performance liquid chromatography separation of adrenal steroids prior to radioimmunoassay: application in congenital adrenal hyperplasia

21-Hydroxylase deficiency (21-OHD) is the most common form of congenital adrenal hyperplasia (CAH), followed by 11beta-hydroxylase deficiency (11beta-OHD). Diagnostic serum markers for these conditions are 17-hydroxyprogesterone (17-OHP) and 11-desoxycortisol (S), respectively. In 21-OHD, the large amounts of 17-OHP are further 11beta-hydroxylated to form 21-deoxycortisol (21-DF), making it also an excellent marker of this disease. These steroids can be measured in blood by radioimmunoassay (RIA). In this paper, we report the use of high-performance liquid chromatography (HPLC) for steroid purification, prior to RIA determinations of 21-DF, S, 17-OHP, and testosterone (T) in ether-extracted serum. The chromatographic separation is developed in a BDS-Hypersil column using water-methanol (53:47, v/v) as the mobile phase. The method is applied to 35 patients with the classic form of 21-OHD (18 females, 17 males, 5.1-14.2 years old) and 2 with 11beta-OHD (1 female, 1 male, 9.5 and 12.6 years old). Thirteen control children (5 females and 8 males, 5.2-15.2 years) are also studied. The results obtained for all measured steroids are compatible with those reported in the literature. The method is precise, and recovery is adequate. The HPLC technique proved to be of value for the purification of several steroids from single serum samples prior to RIA in patients with CAH.     

Ketosteroid profiling using Girard T derivatives and electrospray ionization tandem mass spectrometry: direct plasma analysis of androstenedione, 17-hydroxyprogesterone and cortisol

A function of concentrations of three ketosteroids, [(androstenedione + 17alpha-hydroxyprogesterone)/cortisol], has been shown to provide better discrimination than the concentration of 17alpha-hydroxyprogesterone alone, for the diagnosis of the inherited disease congenital adrenal hyperplasia (CAH). A rapid, direct infusion electrospray ionization tandem mass spectrometry (ESI-MS/MS) method has been developed to measure this ratio in plasma (100 microL). Sensitivity and specificity result from the preparation of mono-Girard T derivatives. Androstenedione, 17alpha-hydroxyprogesterone and cortisol are individually quantitated by isotope dilution. Excellent statistical correlation with radioimmunoassay (RIA) results for the analysis of 17alpha-hydroxyprogesterone is demonstrated. The value of the ratio function of the three ketosteroids is 0.01-0.16 for normal controls (n=26) and 1.83-18.7 for patients with severe CAH (n=4). Profiles of ketosteroids derivatized with Girard T from the plasma of a child with severe CAH, generated by ESI-MS/MS analysis, are shown. Neutral loss scans for 29.5 and 59 Da assist in the identification of the ketosteroids.     

Rapid determination of rifaximin on dried blood spots by LC‐ESI‐MS

The use of blood spot collection cards is a simple way to obtain specimens for therapeutic drug monitoring, assessing adherence to medications and preventing toxicity in a clinical setting. A high‐throughput liquid chromatography–electrospray ionization mass spectrometric (LC‐ESI‐MS) method for determination of rifaximin on dried blood spots (DBS) was developed and validated. It involves solvent extraction of a punch of DBS followed by reversed‐phase LC on a monolithic column consisting of a silica rod with bimodal pore structure and detection by ESI‐MS. Rifampicin was used as an internal standard (IS). The run time was within 5.0 min with a very low back‐pressure at a flow rate of 0.5 mL/min. The assay was linear from 0.1 to 10 ng/mL. The mean recovery was 98.42%. The developed method is very simple, rapid and useful for clinical applications. Copyright © 2011 John Wiley & Sons, Ltd.     

Isocratic reversed phase high performance liquid chromatography determination of twelve natural corticosteroids in serum with on-line ultraviolet and fluorescence detection

An isocratic reversed phase high performance liquid chromatography procedure utilizing ultraviolet and fluorescence detectors linked in series is described for the analysis of cortisone (E), cortisol (F), corticosterone (B), 11-deoxycortisol (S), 11-deoxycorticosterone (DOC), androstenedione (A), testosterone (T), 17-hydroxyprogesterone (17-OHP), progesterone (P), estriol, estradiol, estrone, prednisone acetate and dexamethasone acetate in serum. Serum specimens were extracted with ethyl ether. The optimized mobile phase was methanol + tetrahydrofuran + water (26:18:56, v/v/v). A Shim-pack ODS column was used. The recoveries were 80 to 103%. Intra- and inter-day coefficient of variance were less than 8%. The detection limit is 0.5 pmol per injection volume for estriol, estradiol, E, F and B; 1 pmol for S, A, DOC and estrone; 2 pmol for T and 17-OHP; and 4 pmol for P. Serum from normal subjects and patients with congenital adrenal hyperplasia due to 21- or 17-hydroxylase deficiency were measured, as well as samples of maternal and umbilical cord serum.     

Development of a validated high-throughput LC-ESI-MS method for determination of sirolimus on dried blood spots

A high‐throughput liquid chromatography–electrospray ionization mass spectrometric (LC–ESI‐MS) method for screening of sirolimus on dried blood spots (DBS) was developed and validated. It involves solvent extraction of a punch of DBS followed by reversed‐phase LC on a relatively new monolithic column consisting of a silica rod with bimodal pore structure and detection by ESI‐MS. The run time was less than 3 min with a very low backpressure at a flow rate of 0.5 mL/min. The method can analyze more than 100 samples in an 8 h working day, including sample preparation. The assay was linear from 1 to 100 ng/mL. The mean recovery was 92.42%. The mean inter‐day and intra‐day precisions were 1.23 and 1.41%, respectively. The developed method is simple, rapid and useful for clinical applications. Copyright © 2010 John Wiley & Sons, Ltd.     

A rapid UPLC–MS/MS method for simultaneous separation of 48 acylcarnitines in dried blood spots and plasma useful as a second-tier test for expanded newborn screening

Acylcarnitine profiling in dried blood spots (DBS) is a useful method for high-throughput newborn screening of metabolic disorders, but differentiation of isobaric and isomeric compounds is not achievable. Chromatographic methods for separation have already been reported but are specific for short-chain acylcarnitines or time-consuming. The aim of this work was to develop a fast ultraperformance liquid chromatography (UPLC)-tandem mass spectrometry (MS/MS) method for separation and quantification of a large number of acylcarnitines, including dicarboxylic acylcarnitines and hydroxyacylcarnitines, in DBS and plasma samples. Acylcarnitines from DBS and plasma were converted to their butyl esters and analyzed by electrospray ionization MS/MS. Chromatographic separation was achieved using a UPLC system equipped with an ethylene-bridged hybrid C(18) column. The correlation coefficients of the calibration curves (r(2)) ranged from 0.990 to 0.999. The limit of detection ranged from 0.002 and 0.063 μM for all compounds, and the limit of quantification ranged from 0.004 and 0.357 μM. Precision ranged from 0.8 to 8.8% and the mean recovery was 103%. Profiles of acylcarnitine isomers were investigated in specimens obtained from patients diagnosed with different inborn errors of metabolism. Acylcarnitine concentrations were also measured in 58 term newborns and compared with flow injection analysis measurements. With this newly developed UPLC-MS/MS method, the simultaneous detection of 61 (13 of these labeled) acylcarnitines in DBS and plasma can be achieved in 15 min including postrun equilibration. The method has been validated and can be used as an important component of newborn screening methods as a second-tier test for discrimination and to confirm diagnosis.     

A specific LC/ESI-MS/MS method for determination of 25-hydroxyvitamin D3 in neonatal dried blood spots containing a potential interfering metabolite, 3-epi-25-hydroxyvitamin D3

Vitamin D deficiency in an infant is associated with a wide range of adverse health outcomes in later life. A method for the quantification of 25‐hydroxyvitamin D₃ [25(OH)D₃, the best‐established indicator of vitamin D status] in neonatal dried blood spots (DBSs) using LC/ESI‐MS/MS has been developed and validated. The method employed two steps of derivatization, a Diels–Alder reaction with 4‐phenyl‐1,2,4‐triazoline‐3,5‐dione followed by acetylation, to enhance the detectability of 25(OH)D₃ in ESI‐MS/MS and to separate 25(OH)D₃ from 3‐epi‐25‐hydroxyvitamin D₃ [3‐epi‐25(OH)D₃], a potent interfering metabolite. 25(OH)D₃ was extracted from two DBS punches (3 mm in diameter, equivalent to 5.3 μL of whole blood), purified using an Oasis HLB^® cartridge, and subjected to derivatization prior to analysis with LC/ESI‐MS/MS. 25‐Hydroxyvitamin D₄ was used as the internal standard. This method was reproducible (intra‐ and inter‐assay RSDs, <6.9%) and accurate (analytical recovery, 95.2–102.7%), and the LOQ was 3.0 ng/mL. The developed method enabled specific quantification of 25(OH)D₃ in neonatal DBSs and detection of vitamin D deficiency without interference from 3‐epi‐25(OH)D₃.     

Generation of urinary steroid profiles in patients with adrenal incidentaloma using gas chromatography–mass spectrometry

A method is developed for the determination of steroid hormones in urine using gas chromatography with mass-spectrometric detection. Sample preparation procedure and the conditions of chromatographic analysis were optimized, and characteristic urinary steroid profiles of patients with adrenocortical cancer were obtained. Criteria for the evaluation of the deficiency of 21-hydroxylase and 11β-hydroxylase in patients with adrenal incidentaloma are proposed.     

Newborn screening of phenylketonuria using direct analysis in real time (DART) mass spectrometry

Phenylketonuria (PKU) is commonly included in the newborn screening panel of most countries, with various techniques being used for quantification of l-phenylalanine (Phe). To diagnose PKU as early as possible in newborn screening, a rapid and simple method of analysis was developed. Using direct analysis in real time (DART) ionization coupled with triple-quadrupole tandem mass spectrometry (TQ-MS/MS) and with use of a 12 DIP-it tip scanner autosampler in positive ion mode, we analyzed dried blood spot (DBS) samples from PKU newborns. The concentration of Phe was determined using multiple reaction monitoring mode with the nondeuterated internal standard N,N-dimethylphenylalanine. The results of the analysis of DBS samples from newborns indicated that the DART-TQ-MS/MS method is fast, accurate, and reproducible. The results prove that this assay as a newborn screen for PKU can be performed in 18 s per sample for the quantification of Phe in DBS samples. DART-TQ-MS/MS analysis of the Phe concentration in DBS samples allowed us to screen newborns for PKU. This innovative protocol is rapid and can be effectively applied on a routine basis to analyze a large number of samples in PKU newborn screening and PKU patient monitoring.

快速溶剂萃取-气相色谱/质谱法分析血液中的甲卡西酮

建立血液中甲卡西酮快速溶剂萃取（ASE）-气相色谱/质谱（GC/ MS）分析的新方法. 通过优化 ASE 的萃取条件（溶剂、温度及时间）,对血液中的甲卡西酮进行有效提取,之后用 GC/ MS 进行定性、定量分析. 方法检出限为0. 02 mg / L,定量限为0. 1 mg / L. 血液中甲卡西酮在0. 5、1. 0 和2. 0 mg / L 3 个添加水平的平均回收率在96. 70% ~99. 27%之间,甲卡西酮在0. 1 ~ 50 mg / L 的浓度范围内线性良好. 方法快速、简便、高效且操作自动化,适用于血液中甲卡西酮的检验鉴定.     

Analysis of Dried Blood Spots for Polychlorinated Biphenyls and Organochlorine Pesticides by Gas Chromatography Coupled with Tandem Mass Spectrometry

Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCs) are anthropogenic pollutants highly resistant to chemical degradation and readily absorbed by organic tissue. Their persistence in the environment and toxicological threat to mammals prompts swift, reliable methods of analysis. This study outlines a rapid, efficient and sensitive, validated methodology utilizing a simple liquid extraction technique, and subsequent analysis by gas chromatography coupled with tandem mass spectrometry (GC-MS/MS) for the determination of PCBs and OCs from dried blood spots. The PCBs and OCs were quantified in whole marine mammal blood spotted on Whatman Protein Saver cards (PSCs) by extracting the analytes into acetonitrile acidified with formic acid, followed by GC-MS/MS analysis. The samples were analyzed in positive electron impact (EI+) ionization mode with the electron energy set to 40?eV to preserve analyte integrity. Fortified blood with the analytes of interest was used for method validation and subsequent sample screening. The recoveries of targeted analytes ranged from 62.5% to 107.8%, with relative standard deviations ranging from 0.09% to 4.6% at a 100?ng·mL^?1 concentration level. The method detection limits were from 40.4?ng·g^?1 to 179.2?ng·g^?1 for the PCBs and 37.6?ng·g^?1 to 145.1?ng·g^?1 for the OCs. The use of dried blood spots provided for numerous advantages compared to whole blood samples while demonstrating reduced matrix effects and enhanced sample lifespan while retaining analyte sensitivity.     

Requirements for bioanalytical procedures in postmortem toxicology

The application of analytical techniques in postmortem toxicology is often more difficult than in other forms of forensic toxicology owing to the variable and often degraded nature of the specimens and the diverse range of specimens available for analysis. Consequently, analysts must ensure that all methods are fully validated for the particular postmortem specimen(s) used. Collection of specimens must be standardized to minimize site-to-site variability and should if available include a peripheral blood sample and at least one other specimen. Urine and vitreous humor are good specimens to complement blood. In some circumstances solid tissues such as liver are recommended as well as gastric contents. Substance-screening techniques are the most important element since they will determine the range of substances that were targeted in the investigation and provide initial indication of the possible role of substances in the death. While immunoassay techniques are still commonly used for the most common drugs-of-abuse, chromatographic screening methods are required for general unknown testing. These are still predominately gas chromatography (GC) based using nitrogen/phosphorous detection and/or mass spectrometry (MS) detection, although some laboratories are now using time-of-flight MS or liquid chromatography (LC)–MS(MS) to cover a sometimes more limited range of substances. It is recommended that laboratories include a second chromatographic method to provide coverage of acidic and other substances not readily covered by a GC-based screen when extracts do not include all physiochemical types. This may include a gradient high-performance liquid chromatography (HPLC) photodiode array method, or better LC-MS(MS). Substance-specific techniques (e.g., benzodiazepines, opiates) providing a second form of identification (confirmation) are now divided between GC-MS(MS) and LC-MS(MS) procedures. LC-MS(MS) has taken over from many methods for the more polar compounds previously used in HPLC or in GC methods requiring derivatization. Analysts using LC-MS will need to obtain clean extracts to avoid poor and variable sensitivity caused by background suppression of the signal. Isolation techniques in postmortem toxicology tend to favor liquid extraction; however solid-phase extraction and solid-phase microextraction methods are available for many analytes.     

Development and validation of a sensitive LC‐MS/MS method for determination of tacrolimus on dried blood spots

A bioanalytical method for the quantification of tacrolimus (TAC) on dried blood spots (DBS) using liquid chromatography, electrospray ionization coupled with tandem mass spectrometry (LC‐ESI‐MS/MS) was developed and validated. It involves solvent extraction of a punch disk of DBS followed by liquid–liquid extraction. The analyte and the internal standard (IS, ascomycin) were separated on a phenyl column using an isocratic mobile phase elution at a flow rate of 0.3 mL/min. The assay was linear from 1 to 80 ng/mL. The mean recovery of TAC was 76.6%. Intra‐assay, inter‐assay imprecision and biases were all less than 15%. TAC on DBS was stable for at least 10 days at room temperature, and at least 24 h at 50°C. A chromatographic effect of the filter paper (Whatman 903) was not detected. The volume of blood (15–50 μL) and hematocrit of blood (ranging from 23.2 to 48.6%) did not show a significant influence on detection of TAC concentration by DBS‐LC‐MS/MS. Fifty samples from patients were detected by both DBS‐LC‐MS/MS and microparticle enzyme‐linked immunoassay (MEIA). TAC concentrations measured by DBS‐LC‐MS/MS method tended to be lower than those by MEIA. Copyright © 2012 John Wiley & Sons, Ltd.     

Screening of homocysteine from newborn blood spots by high-performance liquid chromatography with coulometric array detection

Homocystinuria, due to a deficiency of cystationine-beta-synthase, refers to the rare inborn error of the metabolism of homocysteine. The identification and prompt treatment of homocystinuria during the neonatal period can prevent or greatly reduce the severity of the clinical consequences. We report a new method for homocystinuria diagnosis from dried blood spots on newborn screening cards, based on high-performance liquid chromatography with electrochemical coulometric array detection. This method shows an excellent linearity (y=10.36x+0.04; r=0.999), precision (RSDs ranged from 2.7 to 5.8%), recovery (87%) and appears to be a cost-effective approach, being simple, rapid, sensitive and cheap.     

Determination of acetone, hexanal and heptanal in blood samples by derivatization with pentafluorobenzyl hydroxylamine followed by headspace single-drop microextraction and gas chromatography–mass spectrometry

In the study, we developed a simple, rapid, sensitive, and inexpensive method for determination of the disease biomarkers of acetone, hexanal and heptanal in human blood. For the first time, derivatization of carbonyls with O-2,3,4,5,6-(pentafluorobenzyl)hydroxylamine (PFBHA) was combined with headspace single-drop microextractin (HS-SDME) and gas chromatography-mass spectrometry (GC–MS) and applied to the analysis of acetone, hexanal, and heptanal in human blood. At first, acetone, hexanal and heptanal in blood were derivatized with PFBHA and formed oximes in several seconds. Sequentially, the oximes were headspace extracted and concentrated by a microdrop solvent. Finally, the extracted oximes were analyzed by GC–MS. HS-SDME conditions and method validations were studied. Due to needing of only 2 μl organic solvent, short extraction time of 8 min, and simple operation, derivatization-HS-SDME was shown to be a rapid, simple, and inexpensive technique for analysis of acetone, hexanal, and heptanal in human blood. Moreover, it had low detection limit values from 0.24 to 0.62 nM, and good reproducibility (R.S.D. less than 12%).     

稳定同位素稀释技术在人体肝脏维生素A储备量检测中的应用

建立了稳定同位素稀释技术结合高效液相色谱-气相色谱/负化学电离源质谱法(HPLC-GC/NCI/MS)测定人体肝脏维生素A(VA)储备量的方法。志愿者在口服氘标记的视黄醇醋酸酯(²H₈-RAC)后,经21天的稳定期,采集血样,分离血清。血清经正己烷提取,高效液相色谱分离纯化后,氮气吹干供进一步衍生化,衍生化产物用GC/NCI/MS检测,获得标记与未标记VA的丰度比,最后利用Furr-Olson公式计算VA肝脏储备量。在优化的条件下,血清样本中VA的回收率大于85%,精密度(RSD, n=6)小于10%,定量限为26.4 μ g/L,基本满足口服1 mg ²H₈-RAC后标记与未标记VA的检测要求。相比国内现行的人体VA评价方法,该方法能更客观地反映人体VA营养水平。该项测定技术与VA干预实验相结合,可获得某一人群维持体内VA稳定储备水平的膳食摄入量水平。同时,稳定同位素示踪技术的运用对促进经口摄入的VA源在体内生物转化效率的研究也起着重要作用。     

苯丙酮尿症新生儿血斑中辅酶及葡萄糖等物质的分析

苯丙酮尿症(PKU)是新生儿先天性苯丙氨酸羟化酶缺陷所引起的苯丙氨酸代谢障碍疾病.本研究采用超高效液相色谱-质谱联用技术, 测定了5例PKU新生儿出生3天和出生30天后的血斑与20例年龄相仿的正常新生儿血斑中辅酶Q10的绝对含量和辅酶Q9的相对含量,其中,健康新生儿血斑中辅酶Q10的含量为(122.1±24.9) ng/mL,PKU新生儿组的含量为(59.0±12.0) ng/mL.采用气相色谱-质谱联用技术测定了胆固醇和葡萄糖的相对含量.研究结果表明,与对照组相比,PKU新生儿血斑中辅酶Q10、Q9、胆固醇和葡萄糖的含量均显著降低,辅酶Q10的降低与血斑中苯丙氨酸含量升高呈现显著反向相关.本研究结果为PKU患儿的饮食治疗方案提供了依据.