Frans Martens

Serum testosterone levels measured by isotope dilution-liquid chromatography–tandem mass spectrometry in postmenopausal women versus those in women who underwent bilateral oophorectomy

Background Differentiation between subtle changes in low serum testosterone concentrations, common in women and children, is not possible with current commercially available assays. The objectives of the study were to develop a method based on stable isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS) with adequate sensitivity and specificity and to investigate the applicability of this assay in serum samples from pre- and postmenopausal women. Methods For 16 women, testosterone levels were measured in blood samples drawn two years before and after physiological menopause, and for eight women in samples drawn before and after bilateral oophorectomy. Testosterone was extracted from serum, derivatized and analysed on an LC-MS/MS. Results The developed ID-LC-MS/MS method allowed for specific and reproducible measurement of testosterone. Comparison with stable isotope dilution-gas chromatography coupled to mass spectrometry detection by Deming regression analysis gave a slope of 1.025 and an intercept of 0.055 nmol/L (r = 0.9998). A significant decrease was found in testosterone concentrations before and after bilateral oophorectomy (P = 0.02), whereas no significant difference was found before and after natural menopause (P = 0.4). Conclusions The ID-LC-MS/MS assay measures serum testosterone with acceptable accuracy and is useful in female samples, supporting the conclusion that the postmenopausal ovary contributes to circulating testosterone. To our knowledge, our analytical method compares favourably to similar published methods in terms of sensitivity. The sensitivity and specificity of this method comply with the reference method for measurement of testosterone in serum samples of women, children and men suffering from hypogonadism and can also be used for men with testosterone in the reference range.

Comparison of 7 Published LC-MS/MS Methods for the Simultaneous Measurement of Testosterone, Androstenedione, and Dehydroepiandrosterone in Serum

BACKGROUND Recently, LC-MS/MS was stated to be the method of choice to measure sex steroids. Because information on the mutual agreement of LC-MS/MS methods is scarce, we compared 7 published LC-MS/MS methods for the simultaneous measurement of testosterone, androstenedione, and dehydroepiandrosterone (DHEA). METHODS We used 7 published LC-MS/MS methods to analyze in duplicate 55 random samples from both men and women. We performed Passing-Bablok regression analysis and calculated Pearson correlation coefficients to assess the agreement of the methods investigated with the median concentration measured by all methods, and we calculated the intraassay CV of each method derived from duplicate results and the CVs between the methods. RESULTS Median concentrations of testosterone were 0.22-1.36 nmol/L for women and 8.27-27.98 nmol/L for men. Androstenedione and DHEA concentrations were 0.05-5.53 and 0.58-18.04 nmol/L, respectively. Intraassay CVs were 2.9%-10%, 1.2%-8.8%, 2.7%-13%, and 4.3%-16% for testosterone in women, testosterone in men, androstenedione, and DHEA. Slopes of the regression lines calculated by Passing-Bablok regression analysis were 0.92-1.08, 0.92-1.08, 0.90-1.13, and 0.91-1.41 for all testosterone values, testosterone in women, androstenedione, and DHEA. Intermethod CVs were 14%, 8%, 30%, and 22% for testosterone in women, testosterone in men, androstenedione, and DHEA. CONCLUSIONS In general, the LC-MS/MS methods investigated show reasonable agreement. However, some of the assays show differences in standardization, and others show high variation.

Simultaneous measurement of testosterone, androstenedione and dehydroepiandrosterone (DHEA) in serum and plasma using Isotope-Dilution 2-Dimension Ultra High Performance Liquid-Chromatography Tandem Mass Spectrometry (ID-LC-MS/MS).

The adrenal and gonadal androgens, testosterone, androstenedione and dehydroepiandrosterone (DHEA) play an important role in sexual development as well as in other processes. We developed a method for simultaneous quantitative analysis of serum and plasma testosterone, androstenedione and DHEA levels using Isotope-Dilution Liquid-Chromatography Tandem Mass Spectrometry (ID-LC-MS/MS). Samples underwent liquid-liquid extraction and were analyzed on an Acquity 2D-UPLC-System and a Xevo TQ-S tandem mass spectrometer (Waters). The intra-assay and inter-assay coefficients of variation were <4.0%, <6.3% and <7.0% and <6.0%, <8.1% and <7.7% for testosterone, androstenedione and DHEA, respectively. Inter-assay CVs at the lower limit were 10.6%, 16.9% and 9.0% for testosterone (0.10nmol/L), androstenedione (0.10nmol/L) and DHEA (1.0nmol/L), respectively. Recoveries of spiked analytes were 93-107%. The present testosterone method compared well (y=1.00x-0.04; r=0.998) to a published ID-LC-MS/MS method for testosterone in our lab. The latter method being concordant with a published reference method (Bui et al., 2013). The present method compared well to a published ID-LC-MS/MS method (Kushnir et al., 2010) (y=1.06x-0.06; r=0.996 for testosterone; y=1.04x-0.04; r=0.995 for androstenedione and y=1.03x+0.01; r=0.991 for DHEA). In conclusion, we developed a sensitive and accurate ID-LC-MS/MS method to simultaneously measure serum testosterone, androstenedione and DHEA in serum and plasma.

Comparison of eight routine unpublished LC-MS/MS methods for the simultaneous measurement of testosterone and androstenedione in serum

BACKGROUND Liquid-chromatography tandem mass spectrometry (LC-MS/MS) has become the method of choice in steroid hormone measurement. However, little information on the mutual agreement of LC-MS/MS methods is available. We compared eight routine unpublished LC-MS/MS methods for the simultaneous measurement of testosterone and androstenedione. METHODS Sixty random serum samples from male and female volunteers were analysed in duplicate by eight routine LC-MS/MS methods. We performed Passing-Bablok regression analyses and calculated Pearsons correlation coefficients to assess the agreement of the methods investigated with one published method known to be accurate. Intra-assay CV of each method was calculated from duplicate results, recoveries for each method were calculated from six spiked samples. Furthermore, a CV between the investigated methods was calculated. RESULTS The concentrations ranged from 0.05-1.26 nmol/L, 6.15-24.44 nmol/L and 0.15-4.78 nmol/L for testosterone in females, testosterone in males and androstenedione, respectively. The intra-assay CVs were between 3.7-16.0%, 0.9-5.2% and 1.2-9.5% for testosterone in females, testosterone in males and androstenedione, respectively. The slopes of the regression lines ranged between 0.90-1.25, 0.87-1.24 and 0.94-1.31 for testosterone concentrations in females, all testosterone values and androstenedione, respectively. Inter-method CVs were 24%, 14% and 29% for testosterone for concentrations in females and males and androstenedione, respectively. These compare unfavourably to the variation found earlier in published methods. CONCLUSION Although most routine LC-MS/MS methods investigated here showed a reasonable agreement, some of the assays showed a high variation. The observed differences in standardization should be taken into account when applying reference values, or should, preferably, be solved.

Determination of human reference values for serum total 1,25-dihydroxyvitamin D using an extensively validated 2D ID-UPLC-MS/MS method.

BACKGROUND To assess a patients vitamin D status the precursor metabolite 25-hydroxyvitamin D can be determined. However, measurement of 1,25-dihydroxyvitamin D is required when disorders of 1a-hydroxylation, extrarenal 1a-hydroxylation, or vitamin D receptor defects are suspected. METHODS The aim of this study was to determine reference values for 1,25-dihydroxyvitamin D3 and D2 using a 2D ID-UPLC-MS/MS method. RESULTS The LC-MS/MS method, able to measure picomolar concentrations of both 1,25-dihydroxyvitamin D3 and D2 in human serum, was extensively validated. Intra-assay variations were <5% and 8.5% and <7.5% and 11%, for 1,25-dihydroxyvitamin D3 and D2, respectively, over the whole dynamic range (3.1-376 and 3.1-652pmol/L). Limit of quantitation was 3.4pmol/L for both compounds. Our method correlated well with a published LC-MS/MS method (r=0.87) and with the average 1,25-dihydroxyvitamin D3 results of the vitamin D External Quality Assessment Scheme (DEQAS) determined with LC-MS/MS (r=0.93). Reference ranges, determined in 96 plasma samples of healthy volunteers were 59-159pmol/L and <17pmol/L for respectively 1,25-dihydroxyvitamin D3 and D2. The female part of the reference group showed a statistically significant decrease of 1,25-dihydroxyvitamin D3 concentrations with age. The presence of significantly higher average 1,25-dihydroxyvitamin D3 levels in premenopausal women taking oral contraceptive pills compared to postmenopausal women suggests that this effect is estrogen-related, as estrogens lead to a higher vitamin D binding protein. CONCLUSIONS The major finding of the present study is a reference interval of 59-159pmol/L for 1,25-dihydroxyvitamin D3 determined with a highly sensitive and precise LC-MS/MS method.

CSF levels of PSA and PSA-ACT complexes in Alzheimer's disease

Background Prostate-specific antigen (PSA) is a serine protease that in serum, is predominantly found complexed to the serine protease inhibitor alpha1-antichymotrypsin (ACT). ACT co-localizes with amyloid plaques in Alzheimers disease (AD) brain and both PSA and ACT are detectable in cerebrospinal fluid (CSF). Therefore, we aimed to determine whether PSA is produced in the brain and whether PSA and PSA–ACT complex levels in CSF can be used as a biomarker for AD. Methods Levels of ACT and PSA–ACT were determined by sandwich enzyme-linked immunosorbent assay in CSF and serum samples of AD (n = 16), frontotemporal lobe dementia (FTLD) (n = 19), mild cognitively impaired (MCI) patients (n = 19) and controls (n = 12). Total PSA was determined in a non-competitive immunoassay. Reverse transcriptase–polymerase chain reaction (RT–PCR) for PSA was performed on postmortem hippocampus and temporal cortex specimens from control and AD cases. Results PSA is expressed in the brain, as detected by RT–PCR. PSA and PSA–ACT complexes were detectable in CSF of almost all male and only very few female subjects. The levels of PSA and PSA–ACT complexes in CSF did not differ between AD, FTLD, MCI and control groups. PSA CSF/serum quotients highly correlated with albumin CSF/serum quotients. Furthermore, the hydrodynamic radius of PSA was found to be 3 nm and the theoretical PSA quotient, derived from the Felgenhauer plot, corresponded well with the measured PSA quotient. Conclusions PSA is locally produced in the human brain; however, brain PSA hardly contributes to the CSF levels of PSA. PSA and PSA–ACT levels in CSF are not suitable as a biomarker for AD.

Urinary gonadotropin measurements in neonates: a valuable non-invasive method.

Background: To measure low neonatal gonadotropin levels, a sensitive non-invasive method is optimal. The aim of the current study was to validate the Architect i2000SR, an automated immunoassay analyser for the measurement of gonadotropins in unextracted neonatal urine samples against serum gonadotropin levels as a gold standard. Methods: Blood and urine were sampled from 30 approximately six-week-old male and female neonates undergoing elective paediatric surgery. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured and the urine results were corrected for creatinine. Results: The agreement between neonatal serum and urinary FSH was 0.904 (3-5 h between samples) and 0.704 (18-20 h). For LH, the correlation coefficients were 0.785 and 0.507, respectively. Conclusion: We conclude that gonadotropins can be reliably measured using the Architect on randomly voided, non-extracted urine samples collected from neonates by an adhesive device. Urinary gonadotropin levels are a proper reflection of the serum levels.

Determination of cortisol and cortisone in human mother's milk

Humanmothers milk is recommended as the standard nutrition for neonates, due to its widely acknowledged benefits. Besides being a source of nutrients, milk contains a variety of non-nutritive bioactive and immunomodulatory components [1]. Glucocorticoids are found in mothers milk, bound mainly to corticosteroid binding globulin and albumin [2]. Glucocorticoids are suggested to induce proliferation and differentiation of glandular cells in the mammary gland, and also to influence the neonate via the mothers milk [2,3]. Despite efforts to optimize the contents of formula feeding, humanmilk is still recommended for its widely acknowledged benefits. Maternal glucocorticoids might be one of the factors contributing to the advantages of breast milk over formula feeding and are therefore worthwhile to investigate. In order to be able tomeasure glucocorticoids in humanmilk we developed a reliable liquid chromatography–tandem mass spectrometry (LC–MS/MS) method to determine cortisol and cortisone in mothers milk. In this letter, we describe thismethod and the results of the validation of our assay, including experiments that investigated the stability of cortisol and cortisone in human milk. Donor mothers milk from 13 healthy mothers who donated between 8 to 28 weeks postpartum to the Dutch Human Milk Bank of the VU University Medical Center, Amsterdam was used. All samples were stored in polypropylene vials at −20 °C. Preparation of the sampleswas initiated by the addition of H4 labeled cortisol (Cambridge Isotope Laboratories) and H8 labeled cortisone (CDN Isotopes Inc.), both serving as internal standards, to 200 μL thawed milk and thorough mixing. To remove undesired lipids, the milk was washed by the addition of 2 mL hexane [2]. Capped tubes were mixed for 2 min in a multivortexer and centrifuged for 2 min, at 19 °C, 1900 g, resulting in the separation of the lipid layer from the aqueous layer. Thereafter the sample was frozen in a −60 °C CO2 ice bath, which enabled the liquid hexane to be decanted from the frozen milk. This washing procedure was completed three times, in total. Forty μL of the washed milk was injected onto a Symbiosis online solid phase extraction (SPE) system (Spark Holland, Emmen, The Netherlands). Online SPE with C8 cartridges (Spark Holland) was performed for further purification of the samples. The analyte was eluted from the cartridge with methanol–water and focused on the Synergi Hydro RP column (Phenomenex, Utrecht, The Netherlands), which was equipped with a C18 guard column (Phenomenex). A linear binary

Improvement and multicenter evaluation of the analytical performance of an automated chemiluminescent immunoassay for alpha fetoprotein

Background A new ARCHITECT® alpha fetoprotein (AFP) assay was developed to improve the linearity at the upper end of the calibration curve and to enhance other performance characteristics. In addition, this reformulation eliminated the possibility of falsely depressed samples at high AFP concentrations. The purpose of this study was to evaluate its analytical performance at multiple sites. Methods The assay configuration, the diluent formulation, and the manufacturing process were redesigned. Analytical performance was evaluated at Abbott Laboratories, Sapporo Medical University, VU University Medical Center, and Johns Hopkins University. Results The limit of quantitation of the assay was 1.00–1.30 ng/mL. Total precision (%CV) across the assay range varied between 1.41 and 3.52. The assay was linear from 1.19 to 2535 ng/mL, and the range of the assay was expanded from 200 ng/mL to 2000 ng/mL. Comparison of this assay with the on-market ARCHITECT, AxSYM, ADVIA Centaur, DxI, AIA-1800, and E 170 systems yielded regression slopes of 0.91–1.08 and correlation coefficients of ≥0.99 for serum samples. No falsely depressed results were observed in 174 serum samples with AFP concentrations of 2018–1,196,856 ng/mL and in a spiked sample containing up to 10 mg/mL of purified AFP. Conclusions The new AFP assay has improved an issue of the on-market ARCHITECT AFP assay and demonstrated excellent assay performance.

Neurokinin B levels in maternal circulation during early pregnancy.

Abstract Neurokinin B levels were measured between the 10th–20th weeks of pregnancy, i.e., prior to the development of clinical symptoms, in women who developed preeclampsia or delivered a growth-restricted baby. No difference was found in plasma neurokinin B levels, although neurokinin B levels increased slightly towards term.