Correcting false positive medium-chain acyl-CoA dehydrogenase deficiency results from newborn screening; synthesis, purification, and standardization of branched-chain C8 acylcarnitines for use in their selective and accurate absolute quantitation by UHPLC-MS/MS.

While selectively quantifying acylcarnitines in thousands of patient samples using UHPLC-MS/MS, we have occasionally observed unidentified branched-chain C8 acylcarnitines. Such observations are not possible using tandem MS methods, which generate pseudo-quantitative acylcarnitine "profiles". Since these "profiles" select for mass alone, they cannot distinguish authentic signal from isobaric and isomeric interferences. For example, some of the samples containing branched-chain C8 acylcarnitines were, in fact, expanded newborn screening false positive "profiles" for medium-chain acyl-CoA dehydrogenase deficiency (MCADD). Using our fast, highly selective, and quantitatively accurate UHPLC-MS/MS acylcarnitine determination method, we corrected the false positive tandem MS results and reported the sample results as normal for octanoylcarnitine (the marker for MCADD). From instances such as these, we decided to further investigate the presence of branched-chain C8 acylcarnitines in patient samples. To accomplish this, we synthesized and chromatographically characterized several branched-chain C8 acylcarnitines (in addition to valproylcarnitine): 2-methylheptanoylcarnitine, 6-methylheptanoylcarnitine, 2,2-dimethylhexanoylcarnitine, 3,3-dimethylhexanoylcarnitine, 3,5-dimethylhexanoylcarnitine, 2-ethylhexanoylcarnitine, and 2,4,4-trimethylpentanoylcarnitine. We then compared their behavior with branched-chain C8 acylcarnitines observed in patient samples and demonstrated our ability to chromographically resolve, and thus distinguish, octanoylcarnitine from branched-chain C8 acylcarnitines, correcting false positive MCADD results from expanded newborn screening.

Fluorescent derivatization combined with aqueous solvent-based dispersive liquid-liquid microextraction for determination of butyrobetaine, l-carnitine and acetyl-l-carnitine in human plasma.

A novel aqueous solvent-based dispersive liquid-liquid microextraction (AS-DLLME) method was combined with narrow-bore liquid chromatography and fluorescence detection for the determination of hydrophilic compounds. A remover (non-polar solvent) and extractant (aqueous solution) were introduced into the derivatization system (acetonitrile) to obtain a water-in-oil emulsion state that increased the mass transfer of analytes. As a proof of concept, three quaternary ammonium substances, including butyrobetaine, l-carnitine and acetyl-l-carnitine, were also used as analytes and determined in pharmaceuticals, personal care products, food and human plasma. The analytes were derivatized with 4-bromomethylbiphenyl for fluorescence detection and improved retention in the column. The linear response was 10-2000nM for l-carnitine and acetyl-l-carnitine with a good determination coefficient (r(2)>0.998) in the standard solution. The detection limit for l-carnitine and acetyl-l-carnitine was 4.5 fmol. The method was also successfully applied to a 1µL sample of human plasma. In the linearity calculations for determining butyrobetaine, l-carnitine and acetyl-l-carnitine in human plasma, the determination coefficients ranged from 0.996 to 0.999. Linear regression exhibited good reproducibility and a relative standard deviation better than 7.50% for the slope and 9.06% for the intercept. To characterize highly hydrophilic compounds in various samples, the proposed method provides good sensitivity for a small sample volume with a low consumption of toxic solvents.

Bioanalysis and enantioseparation of dl-carnitine in human plasma by the derivatization approach.

BACKGROUND: L-carnitine is an over the counter drug, used to treat disorders like cardiomyopathy, skeletal myopathy, hypoglycemia and hyperammonemia. Preparations containing D-carnitine should be avoided by dialysis patients because it has toxic influence on biochemical processes by inhibiting the carnitine acetyltransferase. Therefore, it is of utmost importance to assess and control the content of D-carnitine. METHODS: A HPLC method was developed and validated for determination and enantiomeric resolution of DL-carnitine in human plasma by derivatization approach. (S)-Naproxen-based three derivatizing reagents were synthesized and applied. CONCLUSION: The limit of detection values were found to be 1.26 and 1.35 ng ml(-1) for the two isomers. The method is simple, reproducible, and can be used for routine analysis in laboratories for control of enantiomeric purity of carnitine.

Continuous-flow microelectroextraction for enrichment of low abundant compounds.

We present a continuous-flow microelectroextraction flow cell that allows for electric field enhanced extraction of analytes from a large volume (1 mL) of continuously flowing donor phase into a micro volume of stagnant acceptor phase (13.4 µL). We demonstrate for the first time that the interface between the stagnant acceptor phase and fast-flowing donor phase can be stabilized by a phaseguide. Chip performance was assessed by visual experiments using crystal violet. Then, extraction of a mixture of acylcarnitines was assessed by off-line coupling to reversed phase liquid chromatography coupled to time-of-flight mass spectrometry, resulting in concentration factors of 80.0 ± 9.2 times for hexanoylcarnitine, 73.8 ± 9.1 for octanoylcarnitine, and 34.1 ± 4.7 times for lauroylcarnitine, corresponding to recoveries of 107.8 ± 12.3%, 98.9 ± 12.3%, and 45.7 ± 6.3%, respectively, in a sample of 500 µL delivered at a flow of 50 µL min(-1) under an extraction voltage of 300 V. Finally, the method was applied to the analysis of acylcarnitines spiked to urine, resulting in detection limits as low as 0.3-2 nM. Several putative endogenous acylcarnitines were found. The current flowing-to-stagnant phase microelectroextraction setup allows for the extraction of milliliter range volumes and is, as a consequence, very suited for analysis of low-abundant metabolites.

Separation of carnitine and acylcarnitines in biological samples: a review.

Carnitine and its acylesters are a family of compounds that can be used in the early diagnosis of many diseases. Carnitine and acylcarnitines have a crucial role in fatty acid transportation. The increased level of free carnitine, total carnitine, or the acylesters can act as biomarkers for many metabolic disorders, including diabetes, encephalopathy and cardiomyopathy. The determination of these compounds is difficult owing to the simple aliphatic structure, the chiral center and the permanent positive charge. Although MS detection can be enough to differentiate between some carnitine derivatives, closely related structural isomers of the acylcarnitines must be separated before detection because they form the same base peak and second most abundant ion peak. Different separation methods are discussed in this review, including reversed-phase, hydrophilic interaction, ion exchange, ion pairing, mixed mode liquid chromatography, gas chromatography and electrophoresis. Representative example chromatograms are shown. The sample preparation and the different derivatization reactions are also covered. A table that summarizes the most important analytical methods by detailing the analyte mixture, the sample matrix, the separation mode and the detection method is provided.

Measurement of free carnitine and acylcarnitines in plasma by HILIC-ESI-MS/MS without derivatization.

Measurement of carnitine and acylcarnitines in plasma is important in diagnosis of fatty acid ß-oxidation disorders and organic acidemia. The usual method uses flow injection tandem mass spectrometry (FIA-MS/MS), which has limitations. A rapid and more accurate method was developed to be used for high-risk screening and diagnosis. Carnitine and acylcarnitines were separated by hydrophilic interaction liquid chromatography (HILIC) without derivatization and detected with a QTRAP MS/MS System. Total analysis time was 9.0min. The imprecision of within- and between-run were less than 6% and 17%, respectively. Recoveries were in the range of 85-110% at three concentrations. Some acylcarnitine isomers could be separated, such as dicarboxylic and hydroxyl acylcarnitines. The method could also separate interferent to avoid false positive results. 216 normal samples and 116 patient samples were detected with the validated method, and 49 patients were identified with fatty acid oxidation disorders or organic acidemias.

Extraction and analysis of carnitine and acylcarnitines by electrospray ionization tandem mass spectrometry directly from dried blood and plasma spots using a novel autosampler.

RATIONALE: Acylcarnitines are routinely analyzed by electrospray ionization tandem mass spectrometry (ESI-MS/MS) both in clinical diagnostic and public health newborn screening laboratories from plasma and dried whole blood spots (DBS) on filter paper. The use of DBS as a convenient method of collecting and storing samples for subsequent analysis of various biomolecules is increasing, thus prompting the development of new devices to recover and quantify such analytes in an automated manner. METHODS: Acylcarnitines were extracted directly from DBS using a novel autosampler that sequentially loads DBS cards into a pneumatic clamp and then pumps a fixed volume of solvent containing appropriate internal standards through a section of the DBS card directly into a triple quadrupole mass spectrometer via ESI. Plasma was first spiked with internal standard then spotted onto filter paper for analysis. RESULTS: Acylcarnitines were analyzed in DBS, and both free and total carnitine were assayed in dried plasma spots (DPS). Results using the new autosampling technique were of equal quality to those obtained by punching a 3-mm diameter disk from a DBS or DPS, then extracting and analyzing the target analytes from conventional 96-well microtiter plates, with far reduced time per sample. Recovery for most analytes was >60% and reproducibility was generally within 20% (CV). CONCLUSIONS: The simplicity and robustness of the DBS autosampler make it an attractive alternative to conventional methods of analyzing DBS specimens, thus saving time and labor costs, especially in high-throughput applications. Although the method as described is for direct infusion analysis, the autosampler is easily coupled to column hardware for applications requiring liquid chromatography/mass spectrometry (LC/MS).

Feasibility of electroextraction as versatile sample preconcentration for fast and sensitive analysis of urine metabolites, demonstrated on acylcarnitines.

In this work, we demonstrate the applicability of electroextraction (EE) to urine metabolites. To investigate which urine metabolite classes are susceptible to EE, off-line EE experiments were carried out with a prototype device, in which urine metabolites were electroextracted from ethyl acetate into water. The obtained extracts were examined with direct infusion MS and the results demonstrated that several compound classes could be extracted, amongst which amino acids and acylcarnitines. Acylcarnitines were selected for evaluation of the performance of EE. For this, the EE setup was adapted to capillary EE (cEE) to be able to analyze large urine sample series, and it was coupled online to LC-MS. cEE-LC-MS of acylcarnitines was optimized and characterized. The recovery, linearity, repeatability, and detection limit of the cEE-LC-MS method was good to excellent. To demonstrate the versatility of EE for sample preparation in analytical procedures, extracts were injected into a CZE-MS system, resulting in detection of the acylcarnitines along with more than 100 presumed metabolite peaks. The results presented here indicate that EE can be used as a fast sample preconcentration technique of low abundant urine metabolites, in combination with both LC and CZE.

Acylcarnitines: analysis in plasma and whole blood using tandem mass spectrometry.

The acylcarnitine profile is a diagnostic test for inherited disorders of fatty acid and branched-chain amino acid catabolism. Patients with this type of metabolic disorder accumulate disease-specific acylcarnitines that correlate with the acyl coenzyme A compounds in the affected mitochondrial metabolic pathways. For example, propionylcarnitine accumulates in patients with both propionic and methylmalonic acidemias. The test identifies and quantifies the species of acylcarnitines in the whole blood or blood plasma of patients at risk for or suspected of having such a disorder. The acylcarnitines are analyzed using electrospray ionization-tandem mass spectrometry. The instrument is used in the precursor ion scan mode to record the molecular species giving rise to fragment ions at m/z 99, derived specifically from the methylated acylcarnitines within the specimen. Quantification is based on the principle of stable isotope dilution, whereby concentrations are derived from the response ratio of each acylcarnitine species to that of a deuterium-labeled acylcarnitine standard. Interpretation of the acylcarnitine profile requires recognition of abnormal concentrations of specific analytes or patterns of analytes and knowledge of their metabolic origin.

Improved tandem mass spectrometry (MS/MS) derivatized method for the detection of tyrosinemia type I, amino acids and acylcarnitine disorders using a single extraction process.

BACKGROUND: Succinylacetone (SUAC), a specific marker for tyrosinemia type I (Tyr I) cannot be detected by the routine LC-MS/MS screening of amino acids (AA) and acylcarnitines (AC) in newborns. The current derivatized methods require double extraction of newborn dried blood spots (DBS); one for AA and AC and the second for SUAC from the blood spot left after the first extraction. We have developed a method in which AA, AC and SUAC are extracted in a single extraction resulting in significant reduction in labor and assay time. METHODS: The 3.2 mm DBS were extracted by incubating at 45 °C for 45 min with 100 µl of acetonitrile (ACN)-water-formic acid mixture containing hydrazine and stable-isotope labeled internal standards of AA, AC and SUAC. The extract was derivatized with n-butanolic-HCl and analyzed by LC-MS/MS. RESULTS: The average inter-assay CVs for, AA, AC and SUAC were 10.1, 10.8 and 7.1% respectively. The extraction of analytes with ACN-water mixture showed no significant difference in their recovery compared to commonly used solvent MeOH. The concentration of hydrazine had considerable impact on SUAC extraction. CONCLUSION: We developed a new MS/MS derivatized method to detect AA/AC/SUAC in a single extraction process for screening Tyr I along with disorders of AA and AC.

Achiral liquid chromatography with circular dichroism detection for the determination of carnitine enantiomers in dietary supplements and pharmaceutical formulations.

A simple and enantioselective method for the separation and determination of carnitine enantiomers in dietary supplements and pharmaceutical formulation samples is proposed. This method is based on achiral liquid chromatographic separation of carnitine enantiomers from interferences and direct circular dichroism (CD) detection. The calibration curve of the anisotropy factor (g) versus the enantiomeric excess was linear, with a correlation coefficient (R(2)) of 0.996. The precision evaluated by UV peak area and CD peak area was suitable (RSD <5% in all cases). The usefulness of the proposed method was demonstrated by analysing natural dietary supplements and pharmaceutical formulation samples. This method has the advantages of being rapid and precise, without using an expensive chiral column. The method was suitable for the simultaneous determination of both enantiomers and for assessing the chemical purity of carnitine.

Analysis of acetylcholine, choline and butyrobetaine in human liver tissues by hydrophilic interaction liquid chromatography-tandem mass spectrometry.

The strong polar quaternary ammoniums, acetylcholine (ACh), choline (Ch) and butyrobetaine (BB, (3-carboxypropyl)trimethylammonium), are believed playing important roles in liver metabolism. These metabolites are at low levels and are weakly retained on reversed-phase liquid chromatographic (RP-LC) columns. Several hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS) methods have been reported to analyze these compounds from different samples. However, no application to human liver tissues has been published. In this study, HILIC-MS/MS method was developed to simultaneously determine these three metabolites in human liver tissues. They were simply extracted from tissue, separated on a HILIC column, and detected by tandem MS in the mode of multiple reaction monitoring (MRM). Further studies on the recovery and repeatability based on real samples indicated the method was accurate and reliable. This method was successfully applied to measure the levels of ACh, Ch and BB in 61 human liver tissue samples including normal, hepatocellular carcinoma (HCC) and matched non-cancerous liver tissues. By comparison of Ch and ACh contents in 29 HCC with their matched non-cancerous liver tissues, it was found that ACh content increased in 11/29 HCC cases and decreased in 13/29 cases. Furthermore, the ACh/Ch ratio increased in 16/29 HCC cases, while it decreased in 8/29 cases. These results strongly indicated that there exist different patterns of ACh content in cancer tissues among HCC patients, thus highlighting the understanding of ACh and its relevant signal pathways in hepatic carcinogenesis and HCC progression.

Separation and identification of plasma short-chain acylcarnitine isomers by HPLC/MS/MS for the differential diagnosis of fatty acid oxidation defects and organic acidemias.

This paper reports a new, high-performance liquid chromatography/tandem mass spectrometry method for the separation and identification of human plasma short-chain acylcarnitine isomers. This simple, rapid procedure involves the use of a single sample previously shown to contain elevated acylcarnitine concentrations by flow injection analysis, and can separate two C4, three C5, two C5:1 and four C5-OH acylcarnitine isomers, thus permitting the differential diagnosis of certain fatty acid oxidation defects and organic acidemias.

Carnitine-esters from the mushroom Suillus laricinus.

Carnitine-esters (1-8) including, a compound (R)-3-hydroxybutanoyl-(R)-carnitine (5), were isolated from the mushroom Suillus laricinus. Their structures were determined by spectroscopic analyses and by total synthesis. One of these, (R)-3-hydroxy-2-methylpropanoyl-(R)-carnitine (4), promoted hyaluronan-degradation by human skin fibroblasts.

Strategy for the isolation, derivatization, chromatographic separation, and detection of carnitine and acylcarnitines.

A strategy for detection of carnitine and acylcarnitines is introduced. This versatile system has four components: (1) isolation by protein precipitation/desalting and cation-exchange solid-phase extraction, (2) derivatization of carnitine and acylcarnitines with pentafluorophenacyl trifluoromethanesulfonate, (3) sequential ion-exchange/reversed-phase chromatography using a single non-end-capped C8 column, and (4) detection of carnitine and acylcarnitine pentafluorophenacyl esters using an ion trap mass spectrometer. Recovery of carnitine and acylcarnitines from the isolation procedure is 77-85%. Derivatization is rapid and complete with no evidence of acylcarnitine hydrolysis. Sequential ion-exchange/reversed-phase HPLC results in separation of reagent byproducts from derivatized carnitine and acylcarnitines, followed by reversed-phase separation of carnitine and acylcarnitine pentafluorophenacyl esters. Detection by MS/MS is highly selective, with carnitine pentafluorophenacyl ester yielding a strong product ion at m/z 311 and acylcarnitine pentafluorophenacyl ester fragmentation yielding two product ions: (1) loss of m/z 59 and (2) generation of an ion at m/z 293. To demonstrate this analytical strategy, phosphate buffered serum albumin was spiked with carnitine and 15 acylcarnitines and analyzed using the described protein precipitation/desalting and cation-exchange solid-phase extraction isolation, derivatization with pentafluorophenacyl trifluoromethanesulfonate, chromatography using the sequential ion-exchange/reversed-phase chromatography HPLC system, and detection by MS and MS/MS. Successful application of this strategy to the quantification of carnitine and acetylcarnitine in rat liver is shown.

Determination of carnitine and acylcarnitines in plasma by high-performance liquid chromatography/electrospray ionization ion trap tandem mass spectrometry.

A high-performance liquid chromatography/mass spectrometry method was developed for the determination of carnitine, its biosynthetic precursor butyrobetaine, and eight acylcarnitines in plasma. The procedure includes a solid-phase extraction for carnitine and short- and medium-chain acylcarnitines, and a liquid-liquid extraction for protein-bound long-chain acylcarnitines, followed by separation on a reversed-phase column in the presence of a volatile ion-pairing reagent. Detection was achieved using an ion-trap mass spectrometer run in the tandem mass spectrometry (MS/MS) mode. The choice of the matrix for calibrators, used for quantification of these endogenous compounds, was also investigated. Validation was performed for standard quality controls diluted with 4% bovine serum albumin solution and for spiked plasma quality control samples at concentrations between 0.5 and 80 micromol/L, depending on the compound. Intra- and inter-day precisions for the determination of carnitine were below 3.4% and accuracies were between 95.2 and 109.0%. Application of the method to the diagnosis of pathological acylcarnitine profiles of metabolic disorders in a patient suffering from methylmalonic aciduria is presented. The method allows quantification of carnitine, butyrobetaine, acetylcarnitine and propionylcarnitine, and semiquantitative analysis of medium- and long-chain acylcarnitines. In contrast with other methods, no derivatization step is needed.

A high performance liquid chromatographic method for the measurement of total carnitine in human plasma and urine.

Total carnitine in plasma and urine can be measured by high performance liquid chromatography (HPLC) using the novel fluorescent derivatisation reagents 6'-methoxynaphthacyl trifluoromethanesulfonate and 2'-phenanthrenacyl trifluoromethanesulfonate. Sample preparation for total carnitine analysis involves: extraction of plasma and urine in methanol, the optional addition of serine betaine as an internal standard, saponification of acyl carnitines with calcium hydroxide, followed by derivatisation with 6'-methoxynaphthacyl trifluoromethanesulfonate or 2'-phenanthrenacyl trifluoromethanesulfonate. The derivatives were separated using an alumina column and measured by fluorescence detection. The coefficient of variation was below 5% using internal standard calibration, and recoveries of acyl carnitines after saponification were over 90%. The total carnitine method was shown to be linear at biological levels for plasma (over the range 30-130 micromol/l) and urine (over the range 80-180 micromol/l). Advantages of this method include good precision, accuracy and linearity, the use of fluorescence to gain sensitivity, the small sample volume required and a relatively low sample preparation time.

Study on conical columns with different conical angles for semi-preparative liquid chromatography.

The dynamic flow profiles and separation performances in conically shaped preparative liquid chromatographic columns (inlet i.d. larger than outlet i.d.) with three different angles (7, 10 and 15) were studied and compared with cylindrical column of the same length and internal volume. The shapes of dynamic flow profiles were studied by on-column visualization method. The transparent chromatographic columns made of polymethyl methacrylate (PMMA), packed with C18 bonded silica, were immerged into a cubic pool filled with glycerol to eliminate the cylindrical and conical lens effect. The flow profiles of colored iodine solution in the columns were observed clearly using cyclohexane as mobile phase since the refractive indices of C18, column wall and the mobile phase are very close. In the conical column of 15 degrees (20-7 mm i.d.) the mobile phase in the central region migrated slower than in wall region as it moved toward the column outlet, while in the conical column of 7 degrees (17-11 mm i.d.) the mobile phase in the central region migrated faster than in wall region just like in cylindrical column. We found that a plug-like flow profile was generated in the conical column of 10 degrees (18-9 mm i.d.) during the whole migration process. A carmine and brilliant blue mixture was used as a probe to test the separation ability of the columns. The resolutions of the two compounds on the conical column of 7, 10, 15 and on the cylindrical column were 0.6, 1.57, 1.29 and 0.8, respectively.

Direct chromatographic resolution of carnitine and O-acylcarnitine enantiomers on a teicoplanin-bonded chiral stationary phase.

R-(-)-Carnitine (vitamin B(T)) plays an important role in human energy metabolism, by facilitating the transport of long-chained fatty acids across the mitochondrial membranes. Its (S)-enantiomer acts as a competitive inhibitor of carnitine acetyltransferase, causing depletion of the body R-(-)-carnitine stock. Consequently, the separation of carnitine enantiomers is very important both to study their biological activities and to control the enantiomeric purity of pharmaceutical formulations. In the present paper we describe an easy, fast and convenient procedure for the separation of the enantiomers of carnitine and O-acylcarnitines by enantioselective HPLC on a laboratory-made chiral column containing covalently bonded teicoplanin as selector. High enantioselectivity factors (alpha values ranging from 1.31 to 3.02) and short-time analyses characterize the analytical procedure; in addition, analytes are easily detected by evaporative light scattering with no need for preliminary derivatization. The effects of pH and ionic strength of the mobile phase and of the nature of the organic modifier on the enantioselective separations were also investigated.