A 7-year-old boy with central diabetes insipidus presenting with thickened pituitary stalk and anti-rabphilin-3A antibody positivity.

OBJECTIVES: A highly invasive pathological diagnosis is necessary to differentiate central diabetes insipidus (CDI) with a thickened pituitary stalk. Lymphocytic infundibulo-hypophysitis (LIH) due to autoimmune involvement of the pituitary stalk is a differentiating disease, and anti-rabphilin-3A antibody (Rab3A-Ab) positivity was recently reported. CASE PRESENTATION: A 7-year-old boy was diagnosed with CDI after having polyuria for two months. He showed growth hormone deficiency with reduced growth rate. Brain magnetic resonance imaging (MRI) revealed a thickened pituitary stalk. The placental alkaline phosphatase level of the cerebrospinal fluid, tumor marker for germ cell tumors, was below the level of sensitivity. No skin or bone findings suggestive of Langerhans cell histiocytosis were detected. Eight months after CDI onset, Rab3A-Ab was positive, and MRI showed shrinking of the thickened pituitary stalk, leading to the diagnosis with LIH. CONCLUSIONS: Rab3A-Ab is a useful adjunctive diagnostic tool for childhood-onset LIH.

Enantioselective determination of ibuprofen in saliva by liquid chromatography/tandem mass spectrometry with chiral electrospray ionization-enhancing and stable isotope-coded derivatization.

A method was developed and validated for the enantioselective determination of trace ibuprofen (IBU) in saliva using liquid chromatography/electrospray ionization-tandem mass spectrometry (LC/ESI-MS/MS) combined with the derivatization using a chiral ESI-enhancing reagent, (S)-1-(4-dimethylaminophenylcarbonyl)-3-aminopyrrolidine (DAPAP), and its isotope-coded analog, (2)H4-DAPAP (d-DAPAP). The DAPAP-derivatization enabled the highly sensitive detection [detection limit, 0.15fmol (equivalent to 30fg of intact IBU) on the column] and complete separation (resolution 3.1) of the IBU enantiomers. The use of d-DAPAP significantly improved the assay precision and accuracy; the intra- (n=5) and inter-assay (n=5) relative standard deviations did not exceed 6.2%, and good accuracy (101.3-106.1%) was obtained. The developed method was successfully applied to the quantitative analysis of IBU in saliva. Using this method, salivary concentration-time profiles of each enantiomer after a single oral administration of the racemic IBU to healthy subjects were obtained. The area under the salivary concentration-time curve of the (S)-enantiomer was ca. twice that of the (R)-enantiomer due to the unidirectional chiral inversion of the (R)- to (S)-enantiomer in vivo. Thus, saliva-based noninvasive pharmacokinetic analyses of IBU enantiomers were achieved by this method.

(S)-1-(4-Dimethylaminophenylcarbonyl)-3-aminopyrrolidine: a derivatization reagent for enantiomeric separation and sensitive detection of chiral carboxylic acids by LC/ESI-MS/MS.

A novel derivatization reagent, (S)-1-(4-dimethylaminophenylcarbonyl)-3-aminopyrrolidine (1-DAPAP), was developed for increasing the detection sensitivity and enantiomeric separation of chiral carboxylic acids by liquid chromatography/electrospray ionization-tandem mass spectrometry (LC/ESI-MS/MS). 1-DAPAP reacted with carboxylic acids at room temperature within 5min in the presence of 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride. The epimerization (racemization) during the derivatization reaction was negligible. The resulting derivatives were highly responsive during the ESI-MS operating in the positive-ion mode and gave a characteristic product ion during the MS/MS, which enabled the sensitive detection using selected reaction monitoring; the detection responses of the 1-DAPAP-derivatives were increased by 10-1100-fold over the intact carboxylic acids and the limits of detection ranged from 0.97 and 5.2fmol on the column. The 1-DAPAP-derivatization was also effective for the enantiomeric separation of chiral carboxylic acids; the resolution values were 1.2-4.3 for the evaluated carboxylic acids. The derivatization procedure was successfully applied to biological sample analyses; the derivatization followed by LC/ESI-MS/MS enabled the separation and detection of trace amounts of ibuprofen and naproxen in human saliva with a simple pretreatment and small sample volume.

Derivatization of chiral carboxylic acids with (S)-anabasine for increasing detectability and enantiomeric separation in LC/ESI-MS/MS.

A simple and practical derivatization procedure for increasing the detectability and enantiomeric separation of chiral carboxylic acids in LC/ESI-MS/MS has been developed. (S)-Anabasine (ANA) was used as the derivatization reagent and rapidly reacted with carboxylic acids [3-hydroxypalmitic acid (3-OH-PA), 2-(ß-carboxyethyl)-6-hydroxy-2,7,8-trimethylchroman (γ-CEHC), and etodolac] in the presence of 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholium chloride. The resulting ANA-derivatives were highly responsive in ESI-MS operating in the positive-ion mode and gave characteristic product ions during MS/MS, which enabled sensitive detection using selected reaction monitoring; the detection responses of the ANA-derivatives were increased by 20-160-fold over those of the intact carboxylic acids and the limits of detection were in the low femtomole range (1.8-11 fmol on the column). The ANA-derivatization was also effective for the enatiomeric separation of the chiral carboxylic acids; the resolution was 1.92, 1.75, and 2.03 for 3-OH-PA, γ-CHEC, and etodolac, respectively. The derivatization procedure was successfully applied to a biological sample analysis; the derivatization followed by LC/ESI-MS/MS enabled the separation and detection of trace amounts of 3-OH-PA in neonatal dried blood spot and γ-CEHC in human saliva with a simple pretreatment and small sample volume.