Elizabeth L. Frank

Rapid HPLC Measurement of Thiamine and Its Phosphate Esters in Whole Blood

BACKGROUND Thiamine (vitamin B(1)) deficiency is associated with severe diseases such as beriberi and Wernicke encephalopathy. Although most Americans have sufficient dietary intake, thiamine deficiency is observed in the alcohol-dependent and elderly populations. Measurement of thiamine concentration in whole blood provides an assessment of vitamin B(1) status in at-risk individuals. METHOD We used TCA to precipitate proteins in whole blood. Thiamine and its phosphate esters were derivatized using potassium ferricyanide to thiochromes, which were separated by gradient elution on a reversed-phase HPLC column and detected by fluorescence. The method was validated for linearity, limit of quantification, imprecision, accuracy, and interference. Results obtained with this method were compared with those produced by the method currently used in our clinical laboratory. Reference values of thiamine and its phosphate esters were determined in samples obtained from self-reported healthy adults who were not taking vitamin supplements. To shorten analysis time, our method used whole blood rather than washed erythrocytes, did not require lengthy enzymatic dephosphorylation, and had a simple mobile phase. RESULTS The method was linear to 4000 nmol/L. The lower limit of quantification was 3 nmol/L. The within-run CV was <3.5% and total CV was <9.4%. This method correlated with our current method (r = 0.97). Approximately 90% of the total thiamine content in whole blood was present as thiamine diphosphate (TDP). The means (ranges) for an apparently healthy population were 114 (70-179) nmol/L for TDP and 125 (75-194) nmol/L for total thiamine. Results for separation and measurement of free thiamine and thiamine phosphate esters in whole blood were obtained within 5.5 min. CONCLUSION We developed an HPLC method that allows separation and measurement of free thiamine and thiamine phosphate esters in whole blood and provides more rapid results than other methods.

Rapid determination of vitamin B2 (riboflavin) in plasma by HPLC

BACKGROUND Riboflavin (vitamin B₂), as the exclusive source for the coenzymes flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) in humans, is a water-soluble vitamin critical for metabolism and energy production. In its coenzyme forms, riboflavin is involved in essential oxidation-reduction reactions. Deficiency leads to skin and mucosal disorders. Measurement of plasma riboflavin can be used to assess vitamin B₂ status in at-risk individuals. METHODS Proteins are removed from plasma by acid precipitation. An aliquot of the resulting supernatant is analyzed by reversed-phase HPLC. Impurities are separated from riboflavin isocratically and the target material is detected fluorometrically (excitation 450 nm; emission 520 nm). RESULTS The method was validated for linearity, limit of quantification, accuracy, precision, and interference. The method was accurate and correlated well (R² = 0.993) to expected concentrations of spiked pooled plasma samples. Imprecision was < 10%. Riboflavin concentrations were determined in samples obtained from self-reported healthy adults who were not taking vitamin supplements. The reference interval established by nonparametric analysis was 6.7-50.1 nmol/l. CONCLUSIONS This HPLC method allows separation and measurement of riboflavin in plasma in 7 min. Results from the assay may be used for clinical diagnosis of deficiency and to monitor therapeutic vitamin supplementation regimes.

Thiamine biosynthesis in Saccharomyces cerevisiae is regulated by the NAD+-dependent histone deacetylase Hst1.

ABSTRACT Genes encoding thiamine biosynthesis enzymes in microorganisms are tightly regulated such that low environmental thiamine concentrations activate transcription and high concentrations are repressive. We have determined that multiple thiamine (THI) genes in Saccharomyces cerevisiae are also regulated by the intracellular NAD+ concentration via the NAD+-dependent histone deacetylase (HDAC) Hst1 and, to a lesser extent, Sir2. Both of these HDACs associate with a distal region of the affected THI gene promoters that does not overlap with a previously defined enhancer region bound by the thiamine-responsive Thi2/Thi3/Pdc2 transcriptional activators. The specificity of histone H3 and/or H4 deacetylation carried out by Hst1 and Sir2 at the distal promoter region depends on the THI gene being tested. Hst1/Sir2-mediated repression of the THI genes occurs at the level of basal expression, thus representing the first set of transcription factors shown to actively repress this gene class. Importantly, lowering the NAD+ concentration and inhibiting the Hst1/Sum1 HDAC complex elevated the intracellular thiamine concentration due to increased thiamine biosynthesis and transport, implicating NAD+ in the control of thiamine homeostasis.

Performance characteristics of an LC–MS/MS method for the determination of plasma metanephrines☆

BACKGROUND Catecholamines and their metabolites, metanephrines, are produced excessively in pheochromocytoma tumors of the chromaffin cells. Increased concentrations of these compounds produce symptoms and allow for clinical evaluation of disease. Historically, screening for such tumors by determination of catecholamines and metabolites in urine yielded false negative results in individuals with a genetic predisposition for the disease and those with paroxysmal hypertension. Analysis of metanephrines in plasma, however, is of decisive diagnostic importance. This test exhibits high sensitivity and specificity for the analytes produced by tumors. METHODS Plasma proteins are removed by solid phase extraction. Chromatographic isolation of the analytes and stable isotope internal standards is achieved by elution on a HILIC column connected to a UPLC MS/MS system. Metanephrines are measured using multiple reaction monitoring with an electrospray source operating in positive ion mode. RESULTS The method was validated for linearity, limit of quantification, accuracy, and precision. The method was accurate and correlated well to a comparison HPLC method. Potential interferences were evaluated. CONCLUSIONS Results from this LC-MS/MS assay enable clinical diagnosis of pheochromocytoma and aid in monitoring treatment outcomes.

Laboratory Monitoring of Heparin Therapy: Partial Thromboplastin Time or Anti-Xa Assay?

The activated partial thromboplastin time (PTT) is the principal method by which laboratories monitor unfractionated heparin therapy. A review of the experimental basis for heparin monitoring by the PTT reveals significant shortcomings of the assay. The availability of anti-Xa heparin assays on automated coagulation analyzers presents a seemingly logical alternative because the PTT therapeutic range is derived from anti-Xa measurements of plasma from heparinized patients. The anti-Xa assay is not susceptible to many of the preanalytical interferences affecting the PTT, and adoption of anti-Xa monitoring would eliminate the need for validating a PTT therapeutic range. However, anti-Xa heparin monitoring has not been rigorously validated by clinical outcomes studies, and decreasing clinical use of unfractionated heparin makes it unlikely that such data is forthcoming. Nonetheless, many laboratories may find themselves in the position of being unable to continue to validate their PTT therapeutic ranges according to current recommendations and accreditation requirements.

Thiamine pharmacokinetics in Cambodian mothers and their breastfed infants

BACKGROUND Thiamine deficiency is common in parts of Asia and causes beriberi. Pharmacokinetics of thiamine in deficient populations are unknown. OBJECTIVE We characterized thiamine pharmacokinetics in Cambodian mothers and their breastfed infants. DESIGN Total plasma thiamine, whole-blood thiamine diphosphate (TDP), and breast milk total thiamine were measured in 16 healthy Cambodian mothers and their infants before and after mothers received oral thiamine hydrochloride (100 mg for 5 d). Assays were also performed in 16 healthy American mothers. RESULTS On day 1, Cambodian mothers were thiamine deficient, with median (range) total plasma thiamine and TDP concentrations of 2.4 nmol/L (0-4.4 nmol/L) and 58.0 nmol/L (27-98 nmol/L), respectively. After a single oral dose, the mean ± SD maximal concentration of thiamine and net area under the thiamine concentration-time curve were 73.4 ± 45.6 nmol/L and 465 ± 241 h · nmol ∙ L⁻¹. Day 6 median maternal total plasma thiamine and TDP concentrations were normal [18.6 nmol/L (13.4-25.3 nmol/L) and 76.5 nmol/L (48-107 nmol/L), respectively; P ≤ 0.001 compared with day 1]. Median Cambodian total breast milk thiamine concentration increased from 180 nmol/L (85-359 nmol/L) on day 1 to 403 nmol/L (314-415 nmol/L) on day 2 and 503 nmol/L (360-808 nmol/L) on day 6; the corresponding American breast milk value was 500 nmol/L (114-622 nmol/L). Median Cambodian infant total plasma thiamine and TDP concentrations increased from 3.0 nmol/L (0-7.3 nmol/L) and 38.5 nmol/L (23-57 nmol/L), respectively, on day 1 to 5.6 nmol/L (0-9.7 nmol/L) and 45.5 nmol/L (32-70 nmol/L), respectively, on day 6. CONCLUSIONS Thiamine-deficient Cambodian mothers effectively absorb oral thiamine, with sharp increases in breast milk thiamine concentrations, but their breastfed infants remain thiamine deficient after 5 d of maternal supplementation. Longer-term maternal supplementation may be necessary to correct thiamine deficiency in breastfed infants. This trial was registered at clinicaltrials.gov as NCT01864057.

Pediatric Urinary Stone Composition in the United States

PURPOSE The incidence of urolithiasis in children is increasing. However, stone composition studies in this population are limited. We sought to determine the effects of age, gender and geographical location on urinary stone composition in the United States pediatric population. MATERIALS AND METHODS We obtained composition analyses for all urinary stones submitted to a reference laboratory between 2000 and 2009. Stones were excluded if the patient was younger than 1 year or older than 18 years. Stone composition was determined by Fourier transform infrared spectroscopy. Logistic regression analysis was performed to determine associations between stone composition frequency and age, gender and geographical region. RESULTS A total of 5,245 stones were included in our analysis. Calcium was found in 89.2% of stones. The percentage of stones containing calcium oxalate increased, while magnesium ammonium phosphate and ammonium acid urate containing stones decreased with age. Calcium oxalate and magnesium ammonium phosphate containing stones were more common in females, while uric acid stones were more common in males. Additionally, significant differences in stone composition frequency were noted between males and females in specific age groups and between age groups within the same gender. Geographical distribution was not significantly associated with stone composition. CONCLUSIONS This series is the largest analysis to date of urinary stone composition in the pediatric population in the United States. Age and gender were significantly associated with stone composition, while geographical region was not significantly associated with stone composition.

A rapid HPLC method used to establish pediatric reference intervals for vitamins A and E.

BACKGROUND Serum concentrations of the fat-soluble vitamins A (retinol) and E (tocopherol) are measured to assess deficiency and, in the case of vitamin A, toxicity. We modified our existing HPLC method for analyzing vitamins A and E by using a high throughput analytical column and small diameter tubing to reduce analysis time. The modified HPLC method was used to establish pediatric reference intervals for these vitamins. METHODS Serum or plasma proteins were precipitated with ethanol. A and E vitamins were extracted into hexane, evaporated under nitrogen, dissolved in absolute ethanol, and analyzed by HPLC with ultraviolet detection. RESULTS The modified HPLC method correlated well with the existing method. Data analysis from the reference interval study resulted in age-dependent intervals for retinol and non-age-dependent intervals for retinyl palmitate, alpha-tocopherol, and gamma-tocopherol. Gender-based reference intervals were not necessary. CONCLUSIONS We validated a rapid HPLC method for analyzing vitamins A and E that decreased run-time by 60%, mobile phase consumption by 39%, and sample injection volume by 50%. The modified method was used to establish pediatric reference intervals for vitamins A and E in samples from 1136 healthy children aged 7 to 17 y.

Urinary metanephrines by liquid chromatography tandem mass spectrometry: using multiple quantification methods to minimize interferences in a high throughput method.

Determination of urinary metanephrines is requested frequently for the differential diagnosis and monitoring of pheochromocytoma. Although numerous methods have been developed, interferences are common and hinder most available assays. This study describes the development, validation and implementation of a reliable high-throughput LC-MS/MS method for the measurement of metanephrine and normetanephrine in urine. Metanephrine and normetanephrine were isolated from urine samples subjected to acid hydrolysis using solid phase extraction on a mixed mode cation exchange sorbent in 96-well format. The extracts were injected directly onto a Restek perfluorophenyl column and separated isocratically in 0.2% formic acid in 5% methanol with a gradient cleanout step to 50% methanol. Detection was accomplished using an API 3200 triple quadrupole mass spectrometer with electrospray ionization in positive mode. Data were acquired in multiple reaction monitoring mode. Three transitions were monitored for metanephrine and its deuterated internal standard; two transitions were monitored for normetanephrine and its deuterated internal standard. Two quantification methods were used to address metanephrine interferences without reducing throughput. The method was linear to 15,000 nmol/L. The limits of detection and quantification were 2.5 and 10 nmol/L, respectively. Within run, between-day and total imprecision values were at or below 1.9%, 2.5% and 2.7% for both analytes. The method correlated well with our previously used GC-MS method. Injection-to-injection time was 6 min. The validated LC-MS/MS method for measurement of metanephrine and normetanephrine in urine specimens was placed into service in August 2010 and has performed exceptionally well.

Performance Characteristics of Four Immunoassays for Antiepileptic Drugs on the IMMULITE 2000 Automated Analyzer

Carbamazepine, phenobarbital, phenytoin, and valproic acid are commonly used antiepileptic drugs that show complicated pharmacokinetic behavior Nonisotopic immunoassays are used routinely to monitor these drugs, and assay specificity is important to obtain accurate results. By using samples from subjects receiving each of these antiepileptic medications, competitive immunoassays for them were evaluated on an IMMULITE 2000 automated chemiluminescent analyzer (Diagnostic Products, Los Angeles, CA). Phenytoin assays were evaluated using an additional set of samples from patients with abnormal renal function. All 4 methods were linear, had imprecision of less than 10%, and compared well with other commercial immunoassays. A positive bias was observed for phenytoin measured in samples from uremic patients compared with a high-performance liquid chromatography reference method. The molar cross-reactivity of carbamazepine-10,11-epoxide was 12% in the carbamazepine assay. Phenytoin metabolites and fosphenytoin had substantial cross-reactivity in the phenytoin assay. All antiepileptic drug assays performed well and are suitable for use in monitoring patients receiving antiepileptic drug therapy. One possible exception is the phenytoin assay with samples from patients with renal insufficiency.