Development of an enzyme immunoassay for serum 16-dehydropregnenolone.

We have developed an enzyme immunoassay (EIA) for serum 16-dehydropregnenolone (3beta-hydroxy-5,16-pregnadien-20-one; 16-DHP). The antiserum against 16-DHP-3-hemisuccinate conjugated bovine serum albumin (16-DHP-3HS-BSA) was raised in rabbits. For use as an enzyme labeled antigen, 16-DHP-3HS was conjugated to alkaline phosphatase. The minimal amount of 16-DHP detected was 4 pg (0.013 pmol)/assay and the measurable range was from 0.06-60 ng/ml (0.191-191 nmol/l). The intra-assay coefficient of variation (C.V.) was 4.1% (0.73+/-0.03 ng/ml, mean+/-S.D., n=6), and inter-assay C.V. was 7.7% (0.13+/-0.01 ng/ml, n=6). A liner relation was observed between the serum sample dilution and the 16-DHP concentration. For the recovery study, authentic 16-DHP was added to a serum sample (original concentration: 0.10-0.14 ng/ml), and the recovery was found to be 94.4-96.8% (final 16-DHP concentrations calculated: 0.29-16.3 ng/ml). To investigate the reliability of the present EIA, the values from our EIA were compared with those obtained by GC-MS. The 16-DHP concentration could not be measured in serum by GC-MS because of its sensitivity. Therefore, the conjugated steroid, 16-DHPS, was first enzymatically hydrolysed and then the 16-DHP measured by both methods. There was a good correlation between the levels determined by these methods (Pearson's correlation coefficient: r=0.927, p<0.001, y=0.74x+3.61, n=27). The serum concentrations of 16-DHP in neonates and umbilical vein were 0.53+/-0.09 ng/ml and 0.88+/-0.61 ng/ml, respectively. No 16-DHP was detected in serum from normal healthy adults using the present EIA. These results suggest that 16-DHP originates from the fetus and neonate.

Serum concentration of androstenediol and androstenediol sulfate in patients with hyperthyroidism and hypothyroidism.

Androstenediol (5-androsten-3beta, 17beta-diol, ADIOL) and androstenediol 3-sulfate (ADIOLS) are active metabolites of dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS), respectively, and have estrogenic activity and immunoregulatory function. We examined serum concentrations of ADIOL, ADIOLS, DHEA, DHEAS and pregnenolone sulfate (5-pregnen-3beta-ol-20-one sulfate, PREGS) in patients with Graves' thyrotoxicosis (male/female 9/14), hypothyroidism (11/20) and in normal controls (14/29). In hypothyroidism serum levels of all these steroids were significantly decreased in both genders. In hyperthyroidism, in contrast, serum levels of ADIOLS (male 1.49 +/- 0.69, female 0.64 +/- 0.31 micromol/l), DHEAS (male 7.43 +/- 3.91, female 5.13 +/- 2.03 micromol/l), and PREGS (male 1.13 +/- 0.58, female 1.07 +/- 0.85 micromol/l) were markedly increased, but serum concentrations of ADIOL and DEHA were not significantly different from controls (ADIOLS male 0.36 +/- 0.33, female 0.14 +/- 0.09 micromol/l; DHEAS male 2.88 +/- 1.70, female 1.86 +/- l1.03pmol/l; PREGS male 0.18 +/- 0.12, female 0.11 +/- 0.08 micromol/l; ADIOL male 3.76 +/- 1.35, female 1.91 +/- 1.17 nmol/l; DHEA male 9.23 +/- 3.49, female 13.5 +/- 10.8nmol/l). Serum concentrations of all these steroids correlated with the serum concentration of the thyroid hormones in these patients. Serum albumin and sex hormone-binding globulin concentrations were not related to these changes in the concentrations of steroids. These findings indicate that serum concentrations of ADIOLS, ADIOL, DHEAS, DHEA and PREGS were decreased in hypothyroidism, whereas serum ADIOLS, DHEAS and PREGS concentrations were increased but ADIOL and DHEA were normal in hyperthyroidism. Thyroid hormone may stimulate the synthesis of these steroids and sulfotransferase is speculated to be increased in hyperthyroidism. Increased ADIOLS might contribute to menstrual disturbances and gynecomastia in hyperthyroidism.

Heterologous enzyme immunoassay for serum androstenediol.

A heterologous enzyme immunoassay for serum androstenediol (Adiol: 3beta, 17beta-dihydroxy-androst-5-ene) was established. The combination of anti-Adiol antiserum raised in rabbit against Adiol 7-O-(carboxymethyl)oxime (Adiol 7-CMO) conjugated bovine serum albumin (Adiol 7-CMO-BSA) and Adiol 7-iminomethylcarboxylic acid conjugated alkaline phosphatase was used for the assay. The sensitivity of the heterologous assay system was superior to that of a homologous assay system in which an antibody raised in rabbit against Adiol 7-CMO-BSA and enzyme labeled antigen, Adiol 7-CMO conjugated alkaline phosphatase, were used. The minimal amount of Adiol detected was 0.4 ngml(-1) and the measurable range was from 0. 4 to 150 ngml(-1). Intra-assay coefficients of variation (C.V.) were 8.6% (1.52+/-0.13 ngml(-1), mean+/-S.D., n=10) and 6.7% (13.4+/-0.9 ngml(-1), n=10). Inter-assay C.V. were 12.9% (1.63+/-0.21 ngml(-1), n=8) and 11.5% (12.2+/-1.4 ngml(-1), n=8). A linear relation was observed between the serum sample dilution and the Adiol concentration. For recovery study, authentic Adiol was added to serum sample (original concentration: 1.43 ngml(-1)). The calculated final Adiol concentration was 2.99 ngml(-1). The recovery was 98.6% (n=5). The Adiol concentrations in healthy subjects measured by the proposed assay (male: 1.1+/-0.3 ngml(-1) (mean+/-S.D.), range: 0.7-1. 7 ngml(-1), age: 22-50, n=10; female: 0.6+/-0.4 ngml(-1), range: 0. 2-1.6 ngml(-1), age: 23-48, n=20) were consistent with reported values.

Serum dehydroepiandrosterone, dehydroepiandrosterone sulfate, and pregnenolone sulfate concentrations in patients with hyperthyroidism and hypothyroidism.

BACKGROUND: Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) have been suggested to have protective effects against cardiovascular disease, cancer, immune-modulated diseases, and aging. We examined serum concentrations of DHEA, DHEA-S, and pregnenolone sulfate (PREG-S) in patients with thyroid dysfunction. METHODS: Steroids extracted with methanol from serum sample were separated into an unconjugated fraction (DHEA) and a monosulfate fraction (DHEA-S and PREG-S), using a solid-phase extraction and an ion-exchange column. After separation of unconjugated steroids by HPLC, the DHEA concentration was measured by enzyme immunoassay. The monosulfate fraction was treated with arylsulfatase, and the freed steroids were separated by HPLC. The DHEA and PREG fractions were determined by gas chromatography-mass spectrometry, and the concentrations were converted into those of DHEA-S and PREG-S. RESULTS: Serum concentrations of DHEA, DHEA-S, and PREG-S were all significantly lower in patients with hypothyroidism (n = 24) than in age- and sex-matched healthy controls (n = 43). By contrast, in patients with hyperthyroidism (n = 22), serum DHEA-S and PREG-S concentrations were significantly higher, but the serum DHEA concentration was within the reference interval. Serum concentrations of these three steroids correlated with serum concentrations of thyroid hormones in these patients. Serum albumin and sex hormone-binding globulin concentrations were not related to these changes in the concentration of steroids. CONCLUSIONS: Serum concentrations of DHEA, DHEA-S, and PREG-S were decreased in hypothyroidism, whereas serum DHEA-S and PREG-S concentrations were increased but DHEA was normal in hyperthyroidism. Thyroid hormone may stimulate the synthesis of these steroids, and DHEA sulfotransferase might be increased in hyperthyroidism.

Simultaneous determination of estriol and estriol 3-sulfate in serum by column-switching semi-micro high-performance liquid chromatography with ultraviolet and electrochemical detection.

A column-switching HPLC with semi-microcolumn enabled us a direct and simultaneous analysis of estriol (E3) and estriol 3-sulfate (E3 S) in human serum in combination with ultraviolet (for E3 S) and electrochemical (for E3) detectors. The mobile phases (phosphate buffer pH 7.0) contained 5 mM tetra-n-butylammonium ion (TBA) as a counter ion for E3 S. Serum samples were diluted with 200 mM phosphate buffer (pH 7.0) containing 100 mM TBA, then injected to the pre-column. After serum proteins had flowed out from the pre-column, E3 and E3 S were transferred to the enrichment column. Subsequently the analytes were eluted to the analytical column. Detection limits of E3 and E3 S in human serum were 2.5 ng/ml and 295 ng/ml. Serum E3 and E3 S levels (mean +/- SD) of umbilical artery from 18 full-term healthy neonates were 33+/-23 ng/ml and 1.26+/-0.69 microg/ml, respectively.

16-Dehydropregnenolone 3-sulfate, its source and metabolism in the feto-placental unit.

We have investigated the serum concentration of 16-dehydropregnenolone (3 beta-hydroxy-5,16-pregnadien-20-one) 3-sulfate (16-DHPS) in the umbilical artery (U.A.), umbilical vein (U.V.) and maternal vein (M.V.) to discover the origin of 16-DHPS. Although there was no significant difference between the levels of 16-DHPS in U.A. (18 +/- 15 ng/ml, mean +/- SD., n = 28) and U.V. (10 +/- 9 ng/ml, n = 28), these values were significantly higher (U.A., p < 0.001; U.V., p < 0.001) than that in M.V. (2 +/- 3 ng/ml, n = 28). These levels in the U.A. and U.V. did not fall in infants (30 +/- 18 ng/ml, n = 7) during the early neonatal period (2-7 d after birth). A significant correlation between the serum levels of 16-DHPS and 16-hydroxypregnenolone (3 beta, 16 alpha-dihydroxy-5-pregnen-20-one) 3-sulfate (16-OH-PregS), which may be the precursor steroid for 16-DHPS, was observed in the U.A. (r = 0.630, n = 28, p < 0.001), but not in the U.V. Moreover, this significant correlation persisted during the early neonatal period (p < 0.05, r = 0.842, n = 7), although the neonate had been separated from the maternal milieu. These results suggest that 16-DHPS originates in the fetus. To confirm the metabolic pathway of 16-DHPS (i.e. pregnenolone (3 beta-hydroxy-5-pregnen-20-one) 3-sulfate (PregS)-->16-OH-PregS-->16-DHPS), we investigated the correlation between the serum concentrations of the precursor steroid and the product in both the U.A. and U.V. A significant correlation was obtained between the serum concentrations of PregS and 16-OH-PregS both in the U.A. (p < 0.001, r = 0.563, n = 28) and U.V. (p < 0.05, r = 0.476, n = 27). As described above, the serum levels of 16-DHPS and 16-OH-PregS only correlated significantly in the U.A. These findings support the existence of the pathway, PregS-->16-OH-PregS-->16-DHPS, in the fetus.

Simultaneous analysis of benzphetamine and its metabolites, and quantitation of urinary p-hydroxy-N-benzylamphetamine by micellar electrokinetic chromatography.

We developed a method for simultaneous analysis of benzphetamine (BZ) and its metabolites, p-hydroxy-N-benzylamphetamine (pHBA), p-hydroxybenzphetamine (pHBZ), amphetamine (AP), methamphetamine and p-hydroxymethamphetamine by micellar electrokinetic chromatography (MEKC). Urine samples from 0-15 h (3-h intervals) after oral administration of BZ (10 mg) were hydrolyzed with beta-glucuronidase (EC 3.2.1.31) at 37 degrees C overnight. The treated urine was applied to a solid phase extraction column Bond Elut Certify. After sequentially washing the column with water, 0.1 mol/l acetic acid and methanol, the samples were eluted with dichloromethane:isopropanol:28% ammonium hydroxide=78.4:19.6:2.0 (v/v %). The eluate was evaporated and the residue dissolved in running buffer was analyzed by MEKC. In urine from 0-3 h, AP, pHBZ and pHBA were detected. After that, only pHBA, which is one of the major metabolites of BZ in human urine, could be detected in the urine by the present method. A method for quantitation of pHBA by MEKC is described here. The effects of acetonitrile and sodium dodecyl sulfate in the running buffer of MEKC on the separation of BZ and its metabolites are also reported.

Prevention of co-elution of steroid sulfates with serum proteins from pre-column in column-switching HPLC system.

A method to prevent co-elution of steroid sulfates with proteins in serum from the pre-column in column-switching HPLC was developed. The pre-column, a polymer-coated mixed function column, was used for ion-pair chromatography with 5 mM tetra-n-butylammonium (TBA) ion. As steroid sulfates, estriol 3-sulfate, dehydroepiandrosterone 3-sulfate and pregnenolone 3-sulfate were used. Human serum (25 microl) was diluted with mobile phases including 5, 100 and 500 mM TBA ion, and then injected directly into the pre-column. The peak areas of the steroid sulfates in serum samples were compared with those of the steroid standards without serum. When 25/microl of serum was diluted with mobile phase including 100 or 500 mM TBA ion, the steroid sulfates in serum were retained in the pre-column; however, the steroid sulfates from the same sample diluted with mobile phase containing 5 mM TBA ion were not retained in the pre-column. Addition of an excess amount of counter ion (TBA ion) into the serum sample made it possible to retain the steroid sulfates in the pre-column. This method was applied to column-switching HPLC for measurement of steroid sulfates in serum using a semi-microcolumn as the analytical column.

Magnetic resonance imaging of osteonecrosis in divers: comparison with plain radiographs.

OBJECTIVE: To assess the diagnostic value of magnetic resonance imaging (MRI) as compared with radiographic findings in osteonecrosis in divers. DESIGN AND PATIENTS: MRI scans and conventional radiographs of the shoulder, hip and knee joints of 23 professional male scuba divers were reviewed together with their clinical findings and personal histories. Correlations between the MRI findings and the radiographic evaluation, clinical symptoms, and personal history were then investigated. RESULTS AND CONCLUSIONS: Lesions found on MRI in 23 divers included 27 in 39 proximal humeri, 17 in 36 proximal femora, 13 in 32 distal femora, and 12 in 32 proximal tibiae. Diffuse, marginated, or irregular patterns were observed. No lesions were seen in epiphyses of the distal femur or proximal tibia. We tried to classify these MRI findings by location and appearance. MRI showed no patients with only one affected bone. A close correlation between the MRI findings and maximum diving depth was observed in the proximal humerus. MRI depicted bone lesions that could not be detected on the radiographs. A routine MRI investigation of the hip joints should be performed in every diver in whom osteonecrosis is diagnosed at another site, for early detection of femoral head osteonecrosis. MRI of the shoulder joint is also the best surveillance in divers who dive deeper than 15 m.

Heterocyclic analogues of quinone methide: preparation and cytotoxicity of 3-oxo-3H-pyrazolo[1,5-a]indole derivatives.

A series of 3-oxo-3H-pyrazolo[1,5-a]indole derivatives was prepared and characterized as heterocyclic analogues of quinone methide. These compounds showed some cytotoxicity to cancer cells, but were ineffective in an in vivo test against murine leukemia L1210.

Serum levels of 16-dehydropregnenolone sulfate during the early neonatal period.

We have established a method for quantifying serum 16-dehydropregnenolone (3beta-hydroxy-5,16-pregnadien-20-one) sulfate (16-DHP S) by GC-MS. The levels of 16-DHP S at birth were compared in infants grouped as extremely immature (gestational age: 22-27 weeks), pre-term (gestational age: 28-36 weeks) and full-term (gestational age: 37-41 weeks). The average of the serum concentration of 16-DHP S in full-term infants was 0.172+/-0.104 micromol/l (n=10, mean+/-S.D.) which was significantly higher than the levels of the extremely immature (0.106+/-0.054 micromol/l, n=14, p<0.05) and pre-term infants (0.088+/-0.066 micromol/l, n=33, p<0.01). However, 16-DHP S in sera from normal adults (age 22-73 years, n=40) was not detected. We investigated chronological changes in serum levels of 16-DHP S during the early neonatal period. In extremely immature and pre-term infants, these levels were significantly higher at 2-7 d than those of 16-DHP S at day 0 (p<0.001). The levels at 8-18 d were still significantly higher than those at day 0 (p<0.05), but in full-term infants, these levels did not change at days 0 and 2-7. These results indicate that 16-DHP S is a steroid specific to fetuses and neonates and the involution of the fetal adrenal gland does not affect its serum levels in the early neonatal period.

C16 hydroxylation of 3beta-hydroxy-delta5-steroids during the early neonatal period.

Temporal changes of the serum levels of 16-hydroxypregnenolone (3beta,16alpha-dihydroxy-5-pregnen-20-one) 3-sulfate (16-OH-Preg S) and 16-hydroxydehydroepiandrosterone (3beta,16alpha-dihydroxy-5-androsten-17-one) 3-sulfate (16-OH-DHEA S) were investigated by analyzing the levels of their precursor steroids, pregnenolone (3beta-hydroxy-5-pregnen-20-one) 3-sulfate (Preg S) and dehydroepiandrosterone (3beta-hydroxy-5-androsten-17-one) 3-sulfate (DHEA S), respectively, in the early neonatal period. The serum levels of these steroids were measured by GC-MS in full-term (gestational age: 37-41 weeks), pre-term (gestational age: 28-36 weeks) and extremely immature (gestational age: 24-27 weeks) infants. The changes in 16-hydroxysteroid production were also investigated by analyzing the ratios of the serum levels of 16-OH-Preg S and Preg S (16-OH-Preg S/Preg S ratio), and 16-OH-DHEA S and DHEA S (16-OH-DHEA S/DHEA S ratio). It was confirmed that the 16-hydroxylation of DHEA S and Preg S increased after birth, and the 16-OH-Preg S/Preg S ratio in full-term infants was significantly higher than in pre-term and extremely immature infants at days 0, 1-6 and 7-13. On the other hand, there were no significant differences between the 16-OH-DHEA S/DHEA S ratios of the three groups at days 0, 1-6 or 7-13. The mechanism of differences in the 16-hydroxylation of Preg S and DHEA S is also discussed.

Studies on steroids in fetuses and neonates: identification of 16-dehydropregnenolone in the circulation of pre-term neonates.

Unconjugated steroids were extracted with dichloromethane from the serum of pre-term neonates. Conjugated steroid fraction in the residue was separated and purified by high performance liquid chromatography. The purified steroid fraction was subjected to enzyme (arylsulfatase from Helix pomatia) or acid hydrolysis. Liberated steroid was analyzed by gas chromatography-mass spectrometry (GC/MS) and gas chromatography-Fourier transformation infrared spectroscopy (GC/FT-IR). All of the results obtained from GC/MS and GC/FT-IR analysis were identical with those of authentic 16-dehydropregnenolone (3 beta-hydroxy-5,16-pregnadien-20-one, 16-DHP). This is the first report to demonstrate the presence of 16-DHP in human blood.

[A study of risk factor in osteoporosis, femoral neck fracture and colles' fracture].

This work studied risk factors of osteoporosis, femoral neck fracture and Colles' fracture. The results were compared with those of a healthy group. Milk intake was frequent in the healthy group, but rare in the femoral neck fracture or Colles' fracture group. Most of osteoporosis and femoral neck fracture group were bed ridden, or stayed indoors for a long time before injury. They weighed less and were thin as compared to the healthy group. Decrease of activities of daily living and less body weight were risk factors of osteoporosis and femoral neck fracture, but these risk factors were more predominant in the femoral neck fracture than osteoporosis group. In this study, 74.4% of the patients with femoral neck fracture also had osteoporosis and 33.3% with Colles' fracture had osteoporosis. Colles' fracture was related to injury force and femoral neck fracture was found to be closely related to osteoporosis.

Enzyme immunoassay for serum dexamethasone using 4-(carboxymethylthio)dexamethasone as a new hapten.

A sensitive and simple enzyme immunoassay for direct quantitation of serum dexamethasone was established. An antiserum with high specificity was produced by the immunization of rabbits with a newly synthesized 4-(carboxymethylthio)dexamethasone-bovine serum albumin conjugate. Alkaline phosphatase was used as a labeling enzyme. The minimum amount of dexamethasone detected was 2 pg per tube on the basis of B/Bo 100 - 2 SD (%) of standard curve. However, taking into account the cross-reaction with steroids such as cortisol in dexamethasone-free serum, the measurable range was from approximately 0.13 to 10 micrograms/dl. Intra- and interassay coefficients of variation were 1.5 - 5.4% and 0.6 - 6.5%, respectively. Serum levels of dexamethasone and cortisol in four normal subjects after an oral administration of 1 mg of dexamethasone are also reported.

[Instructions on family planning at the ambulatory clinic of Nagasaki University Hospital: the current status of training in pessary use].

PIP: Education in pessary use at the outpatient clinic of Nagasaki University Hospital was reviewed. 27 women, who had recovered from childbirth and postpartum of 2 months or more, were admitted to the program. The program consisted of 1 group session and 4 private instructions. In the group session family planning in general and contraceptive devices in detail were described and discussed. At the end of the general session each patient was asked to select one method of contraception. Private instructions included the lecture on the anatomy of female organs related to pessary use, determining the size of pessary via internal examination, locating portio by tactile sense, actual fitting of pessary by the clinical staff and removal by the patient. After practicing a few times the patient acquired necessary skills. 16 users of pessary were followed up at 2 weeks, 1 month, and 2 months. In 2 weeks the patients used pessary 1-5 times. They experienced no discomfort, hemorrhage, or abnormal discharge. Removing pessary was more difficult than inserting. The patients agreed that having the same midwife throughout the private sessions was helpful. They have continued to use pessary for 10 months-2 years and 4 months.^ieng