= Discovery stage.
= Translation stage.
= Clinically available.

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MSACL 2019 EU Abstract(s) for


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Podium Presentations for


Selected Ion Flow Tube Mass Spectrometry SIFT-MS for Real-Time Measurement of Trace Concentrations of Volatile Compounds in Breath and Culture Headspace

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Wednesday at 14:30

INTRODUCTION
The need for rapid and accurate measurement of trace concentrations of compounds present in air and human breath has led to construction of specialised mass spectrometers based on the Selected Ion Flow Tube Mass Spectrometry, SIFT-MS, and its drift tube variant, SIFDT-MS.

OBJECTIVES
The primary objective was to quantify in real time volatile compounds including ammonia, hydrogen sulphide or hydrogen cyanide present in concentrations as low as a part per billion by volume (ppbv) in human breath and in the headspace of bacterial cultures. The specific objective was to reduce the size of the instrumentation whilst improving sensitivity.

METHODS
The selected reagent ions (either H3O+, NO+ or O2+) for selective chemical ionization of volatile compounds present in the air matrix are created in an external ion source and injected into the the flow or flow-drift tube reactors with well-defined reaction time. The absolute concentrations of the analytes can thus be accurately quantified using the chemical kinetics principles.

RESULTS
Concentrations of volatile metabolites present in breath were determined by SIFT-MS in several case studies focused at ammonia, acetone, hydrogen cyanide, methanol, pentane and acetic acid. In vitro studies of the VOCs emitted by bacteria illustrate the search for exhaled breath biomarkers of airways infections.

CONCLUSION
SIFT-MS is now recognized as a valuable method for the analysis of air and breath allowing real time analysis on time scale of seconds, minutes or hours. SIFDT-MS has a potential for construction of much smaller instruments for accurate analyses in matrices such as exhaled breath and bacterial culture headspace.


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Quick Pathogen Identification and Antibiogram for the Clinics by MS/MS Proteotyping

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 10:50

Mass spectrometry is a powerful tool to identify pathogens. However some issues such as mixture handling are usually beyond reach of whole-cell MALDI-TOF approaches. We developed a tandem mass spectrometry approach which addresses without a priori any kind of isolates but also more complex samples such as mixtures of organisms. Based on the analysis of the whole set of identified peptides from the sample, a phylogenetic information is quickly processed and presented in a format easily accessible for the clinician. An in-house developed microbiota reference standard comprising 24 different microorganisms was used for optimizing parameters for data acquisition by tandem mass spectrometry and data processing. Furthermore, the peptide signal is automatically search against a protein sequence database listing all the proteins involved in antibiotic resistances. This allows obtaining a quick pathogen identification and proposing an in silico antibiogram. This pipeline has been challenged with hundreds of clinical samples and resulted very robust. This work paves the way to wide proteotyping applications in the clinical lab.


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Podocyturia Evaluation in Women with Preeclampsia and Fabry Disease Patients Using a Tandem Mass Spectrometry Approach

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 14:50

Introduction. Podocyturia is a possible early sign of kidney abnormalities in patients. Currently, kidney damages are assessed using proteinuria measurements and the estimated glomerular filtration rate. Unfortunately, these parameters might not always be efficient in early detection of all patients. Most analytical techniques for the analysis of podocyturia are tedious, time-consuming, and may lead to results variability. We opted to develop a reliable methodology for podocyturia evaluation in patients with kidney involvement.
Objectives. The main objective of this project was to devise an efficient analytical tool for the analysis of peptides characteristic of podocyte proteins (podocin and podocalyxin) using a tandem mass spectrometry (MS/MS) method for early diagnosis of various kidney abnormalities. Random urine samples from women with preeclampsia, Fabry disease patients and controls were analyzed and correlations with other kidney disease biochemical parameters evaluated.
Method. A reversed-phase ultra-performance liquid chromatography coupled to a tandem mass spectrometry (UPLC-MS/MS) method was developed/validated to quantify peptides of podocalyxin and podocin in urine supernatant by using specific cleavable peptides and standards. One mL was pipetted from the supernatant of centrifuged random urine samples. A heavy cleavable peptide standard was added for each protein. Samples were treated with sodium deoxycholate, dithiothreitol and iodoacetamide prepared in an ammonium bicarbonate buffer to ensure an optimal trypsin digestion (2 h at 37oC). Tryptic peptides were purified by solid-phase extraction and evaporated. Samples were resuspended, filtered and analyzed using an Acquity-I Class Xevo UPLC TQ-S MS/MS (Waters Corp.).
Results. Peptides [ATFNPAQDK+2H]2+ (m/z 496.25->558.29 (y5)) and [APAATVVDVDEVR+2H]2+ (m/z 671.35->831.42 (y7)) were selected to quantify podocalyxin and podocin, respectively. The validation of the method for intraday- and interday assays showed biases below 15%. The molecules were stable at -20oC and -80oC. Our results show that a severe albuminuria content in urine samples did not unfavorably impact on the results. Podocalyxin levels were higher than podocin levels in patients, especially in pregnant women. Women with preeclampsia had abnormal levels of both proteins with a higher sensitivity for podocalyxin. Slightly increased levels of podocin were observed in Fabry males, while both protein levels were increased in untreated Fabry females compared to controls. Positive correlations were found in the preeclampsia groups: podocalyxin and podocin levels correlated with blood pressure, albuminuria and proteinuria levels. In the Fabry groups, podocalyxin levels correlated with urine glycosphingolipids, such as globotriaosylceramide and globotriaosylsphingosine levels.
Conclusion. This multiplex quantitative podocyturia methodology is reliable. It is a valuable investigative tool for patients with kidney involvement.


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Biomarker Discovery and Translational Research Leading to Clinical Utility: Experimental Approaches and Pitfalls

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Thursday at 14:30

This session will focus on three aspects of clinical analyses: 1) the discovery of biomarkers using semi- and untargeted metabolomic approaches; 2) the “de novo” structural elucidation of biomarkers; and 3) the quantitative analysis of biomarkers in the clinical field. The focus on biomarker discovery will be on the choice, collection and preparation of samples for optimal results and to prevent the risk to create artificial biases between the patient and control groups. Different aspects concerning the UPLC/MS analysis of samples will be addressed to increase the quality of the dataset and to obtain the necessary information to optimize the alignment (data mining) of the results. Other tools, such as various mathematical transformations applied to the marker peak areas, will be presented to improve biomarker discovery based on their abundance. Multivariate analyses, mainly the supervised orthogonal partial least-square discriminant analysis (OPLS-DA) statistical method, will show how to target biomarker candidates. In the second part of the seminar, tips on the structural elucidation of biomarkers by tandem mass spectrometry will be presented. Often, novel biomarkers are not listed in tandem mass spectrometry data banks. Therefore, tools will be presented to perform “de novo” structural elucidation of molecules. The issue related to the presence of structural isomers interfering with the interpretation of a biomarker fragmentation spectrum will be presented. The last part of the seminar will be dedicated to the development and validation of Multiple Reaction Monitoring (MRM) methods for the quantitative analysis of biomarkers. Two examples of UPLC methods optimization allowing the separation of the biomarker from structural isomer interferences will be presented as well as how to reduce matrix effects. During this Practical Training Track presentation, biomarker results for Parkinson’s disease and various genetic diseases such as Fabry and Gaucher diseases will be used as clinical applications.


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Comprehensive Glycopeptide Profiling in Blood Plasma for Clinical Applications

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 11:00

Background:
Almost all proteins in human blood plasma carry glycan structures that impact not only physical properties like solubility but also protein function. Glycoproteins are regarded as high potential biomarkers in blood plasma since aberrant glycosylation is known to occur in various diseases. At present, the glycosylation status of proteins in blood plasma can be determined via released N glycan profiling or targeted analysis of a single glycoprotein. However, these are only incomplete analyses that do not cover the unique combination of glycosylation of several proteins. Glycopeptide profiling offers the potential to generate site-specific glycosylation profiles for hundreds of proteins in a single experiment. To this end, we have developed an innovative glycopeptide profiling approach for blood plasma.

Methods:
Blood plasma was obtained from healthy individuals and selected patients with congenital disorders of glycosylation (CDG). The plasma samples were digested by trypsin and glycopeptides were enriched using Sepharose material. Enriched glycopeptides were then analysed by LC-MS using C18 reversed phase material for HPLC separation coupled to online MS detection using an ESI-qTOF instrument. In-source charge manipulation was performed using organic solvents (nanoBooster, Bruker Daltonics), among others to enhance signal intensity as glycopeptides often show difficulties in ionization under routine ESI conditions. Data dependent CID MS/MS spectra were recorded with optimized settings that favour glycan- or peptide-moiety fragmentation. Glycan moieties were identified in GlycoQuest (Bruker Daltonics) and peptide moieties in MASCOT (MatrixScience). Matlab-based (MathWorks) scripts were developed to integrate all data and to identify differences in glycosylation by multivariate data analysis.

Results:
More than 10.000 unique deconvoluted monoisotopic features were detected at >75% group count between samples. Results obtained by glycopeptide profiling were validated by comparison with released N-glycan profiling and intact glyco-Transferrin LC-MS. Using multivariate analysis, we were able to unambiguously differentiate healthy individuals from patients with known CDG gene defects. The variable importance in projection was used to identify glycopeptide biomarkers for specific gene defects.


Conclusion:
This approach enables comprehensive glycopeptide profiling in blood plasma for clinical applications.

Keywords:
Glycoproteomics, Glycopeptide, Biomarker, Blood plasma, Supercharging.


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Computational Analysis of Mass Spectrometry Data for Standardised Diagnosis of Inborn Disorders of Steroidogenesis

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 11:10

Introduction: The adrenal cortex and gonads produce steroid hormones involved in salt and glucose homeostasis, blood pressure regulation, stress response and sex differentiation. These hormones are produced via a series of enzymatic steps and metabolites of steroids from each step are excreted and measurable in urine. Inborn disorders of steroidogenesis result from genetic mutations in distinct enzymes, causing a block in hormone production and lead to several forms of Congenital Adrenal Hyperplasia (CAH) and differences in sex development (DSD). Each enzyme deficiency is characterised by a distinct pattern of altered excretion of individual steroid metabolites relating to the specific enzymatic block. Ratios of urine steroid metabolites measured by gas chromatography-mass spectrometry (GC-MS) can be employed as surrogates of distinct steroidogenic enzyme activities. Widespread use of GC-MS multi-steroid profiling for rapid diagnosis of these disorders in the acute setting is often hampered by lack of specialist expertise. Here, we developed a novel steroid metabolomics approach for the detection and differentiation of inborn steroidogenic disorders, comparing its performance to that of conventional biochemical analysis by established steroid metabolite ratios.
Methods: We performed multi-steroid profiling by GC-MS in urine samples from 829 healthy controls and 178 patients with inborn steroidogenic disorders. This included the following enzyme deficiencies: CYP21A2(n=26), CYP11B1(n=12), CYP17A1(n=30), POR(n=37), HSD3B2(n=22), SRD5A2(n=51). We assessed the diagnostic performance of conventional biochemical diagnosis based on 14 previously published steroid metabolite ratios, indicative of distinct enzyme reactions. We compared this to the performance of a novel, machine learning-based steroid metabolomics algorithm applied to the GC-MS steroid profiling data, Angle Learning Vector Quantization (ALVQ). ALVQ uses 496 steroid metabolite ratios (all pairwise combinations of 32 measured metabolites) to classify samples by comparing similarity (quantified as cosine of the angle) of their steroid metabolome to learned representative steroid metabolome prototypes for each inborn disorder.
Results: ALVQ showed excellent sensitivity and specificity in the training set (100% and 99.7%, respectively), and good generalisability with sensitivity and specificity on testing random subsets of 89.6% and 99.0%, respectively. In comparison, conventional biochemical diagnosis, using 97.5% age and gender matched normative limits, demonstrated comparable sensitivity of 90.9%, but inferior specificity of 73.9%.
Discussion: We present a steroid metabolomics approach with acceptable performance for non-invasive, rapid and automated differentiation of inborn steroidogenic disorders. This approach is suited to facilitate much more widespread availability of steroid metabolome analysis for routine diagnosis but also to provide novel insights into steroid pathway systems.


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Proteomic Discovery and Validation of the Confounding Effect of Heparin Administration on the Analysis of Candidate Cardiovascular Biomarkers

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 10:50

BACKGROUND: Several plasma proteins have been suggested
as markers for a variety of cardiovascular conditions
but fail to qualify in independent patient cohorts.
This may relate to interference of medication on plasma
protein concentrations. We used proteomics to identify
plasma proteins that changed in concentration with heparin
administration and therefore potentially may confound
their evaluation as biomarkers in situations in
which heparin is used.

METHODS: We used a proteomic approach based on
isobaric tagging and nano-LC-MS/MS analysis to
quantify several hundred proteins in a discovery study
in which individual plasma samples from 9 patients at
intravascular ultrasound follow-up 12 months after an
acute myocardial infarction before heparin administration
and 2, 15, and 60 min after heparin administration;
we validated our findings in 500 individual
plasma samples obtained at admission from patients
with suspected ST segment elevation myocardial infarction
(STEMI), of whom 363 were treated with
heparin before admission.

RESULTS: In the discovery study, 25 of 653 identified
plasma proteins displayed a changed concentration after
heparin administration (Bonferroni-corrected P
value at P < 7.66 x 10-5). Fourteen of the proteins
changed significantly among heparin-treated patients in the
validation study (nominal significance level of P < 6.92 x
10-5). Among heparin-affected proteins in both the discovery
study and the validation study were midkine, spondin 1,
secreted frizzled-like protein 1, lipoprotein lipase, and follistatin,all previously associated with STEMI.

CONCLUSIONS: Medications such as heparin administration
given before blood sampling may confound biomarker
discovery and should be carefully considered in
such studies.


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An Ultrasensitive High-Throughput LCMS/MS-Method for Estradiol and Estrone in the Sub-Picomolar Range

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 11:40

Background: We intended to develop a high-throughput LCMS-method to measure sub-picomolar levels of estradiol (E2) and estrone (E1). The method should be able to differentiate between pretreatment and suppressed blood levels of E2 and E1 in postmenopausal breast cancer patients undergoing aromatase inhibitor (AI) treatment, and should be well applicable in a routine lab.

Method: Our method development strategy involved extensive optimization of a less sensitive (LOQ 13 pmol/L) LC-MS/MS routine method for E2 currently in use in our lab. Systematic approach to the LLE sample preparation step, including solvents and mixing conditions resulted in optimal outcomes with regard to extraction recovery and sample purity. In brief: Serum or plasma samples were spiked with isotopically labeled internal standard and extracted in 96-well plates with hexane:methyl tert-butyl ether in an automated procedure (Hamilton Star Line). Reconstituted extracts were analyzed using LC-MS/MS (SCIEX API6500+) in negative ESI mode. Certified reference materials (CRM), and quality controls (QC) made from pooled patient sera were used to validate sensitivity, accuracy and precision of the method.

Results: Sample preparation, including LLE, evaporation and reconstitution is performed in about 4 hours. UPLC total run time is 10 min, including wash steps. Method performance: The limit of detection (LOD) for E2 and E1 was estimated to 0.3 pmol/L and 0.2 pmol/L, respectively. The limit of quantification (LOQ) was 0.6 pmol/L (E2) and 0,3 pmol/L (E1). Precision: the CV was below 9.0 % at all QC levels for E2, and 7.8 % for E1. The method is free of matrix-effects and is traceable to the E2 reference standard BCR576. Using healthy blood donors, reference ranges for E2 and E1 in postmenopausal women (>55 years, no estrogen supplements) were obtained. We confirmed ultra-low E2 and E1 levels in sera from patients using aromatase inhibitors such as Letrozole and Exemestane.

Conclusions: We have developed and validated a high-throughput LCMS/MS method for sub-picomolar levels of E2 and E1 and demonstrated its utility for postmenopausal breast cancer patients on AI. The assay is characterized by excellent accuracy and precision, and is traceable to a certified reference standard. The method was in February 2019 implemented in our lab for routine assessment and follow up of breast cancer patients.


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Application of a Molecular Networking Approach for Therapeutic Drug Monitoring (TDM) and Toxicology

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 10:30

Introduction: In TDM and toxicology, the analyst is often confronted with complex problems, where results can have important clinical consequences. Untargeted screening is an analytical challenge, given the high number of molecules to be detected and the lack of standards available. Considered to be the reference method for screening, liquid chromatography coupled with high-resolution tandem mass spectrometry (LC-HRMS) generates a large volume of high quality spectral data, with a lack of tools for visualizing and organizing MS data of these compounds. Here, we applied molecular networking for untargeted screening interpretation.
Objectives : (i) build a mass spectral library of drugs found in intoxication and apply this database (DB) for drug’s identification in hospitalized patients; (ii) compare theoretical mass spectral libraries obtained by in silico fragmentation with the present DB to allow broadening its fields of application.
Methods : For the DB, each drug was diluted in methanol at 1 mg/mL. For the clinical samples, 100 μL of plasma were added to 100 μL of acetonitrile and centrifuged. 5µL of the supernatant were injected onto the LC-HRMS system. Analyses were carried out on an Orbitrap Q Exactive mass spectrometer coupled to a Dionex Ultimate 3000 LC system. LC separation was performed on a xbridge C18 column (50 x 4.6 mm, 3.5 μm). Mobile phases were 0.1% formic acid in water (A) or acetonitrile (B). For the DB, an LC gradient program was performed from 95 to 5% A with a 17 min run time, whereas for the clinical sample, the program extended to 45 minutes, with a 200 μL/min flowrate. For the MS, there were three scan events: positive MS (m/z 50-1000), two data-dependent MS/MS scans of the 1st and 2nd most intense ions from the first scan event. For MS/MS data, CID and HCD activation types were recorded.
Results : For the DB, around 200 compounds were recorded including drugs found in hospitalized patients, belonging to psychotropes, benzodiazepines, antidepressants, opiates, anti-infectives. Using this DB, we confirmed in more than 20 patients, among others, intake of bromazepam, amitryptiline, levetiracetam, tramadol, voriconazole. The molecular network approaches confirmed results obtained by references methods used daily in clinical laboratories like GC- or LC-MS. In a 2nd step, comparison was made between our DB and in silico MS/MS spectra using CFM-ID to further annotate drugs metabolites. Over the 200 drugs, CFM-ID gave identical results and these approaches may lead to additional metabolite annotations.
Conclusion : Our results show that the use of molecular networking opens perspectives in TDM and toxicology in biological matrices using LC-HRMS. Combined with CFM-ID to extend the annotation of new potential drugs or old drug’s metabolites, it could help clinicians to better understand drug-drug interaction and therefore explain potential toxicity or lack of efficacy in patient’s treatments.


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Precise Quantitative Serum LC-MS/MS Profiling: The Impact of Sample Preparation and Sample Source on Biomarker Discovery Studies

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 10:30

INTRODUCTION: Reliable specific biomarkers are essential for the improvement of diagnosis and accelerated drug discovery. Biofluids like plasma and serum are unique sources of potential biomarkers, capable of revealing an organism’s status. However, despite major efforts and significant investment, only a limited number of new biomarkers stand up to the scrutiny of validation via the analysis of large sample cohorts. Serum extraction is a facile procedure capable of delivering a high consistency of processed samples independent of origin and operator. However, variables such as the collection tube material, blood clotting time, centrifugation speed and temperature etc., can have detrimental effects on the concentration of so-called "contaminating proteins" derived from blood cells.
OBJECTIVE and METHODS: Here we describe a set of novel fast and reproducible low-flow LC-MS/MS methods suitable for label-free quantification of proteins in crude serum samples using the UltiMate 3000 RSLCnano system coupled to a Q Exactive HF-X HRAM MS. The high reproducibility of these methods permitted the study of the impact of both technical (run-to-run) and biological variation. Alterations in serum protein abundance was observed that are likely caused by artifacts in sample preparation corresponding to serum from four different serum sources.
RESULTS: The methods afforded throughputs of 180, 100, 60, 30 and 24 samples per day, respectively. The shortest permitted the profiling of more than 140 proteins and identification of 1340 peptide groups whilst the longest method, comprising a 60 min total cycle time, enabled the profiling of more than 250 proteins based on 2900 peptide groups. 233 proteins (90%) were quantified with CVs below 15%. Analysis of biological replicates revealed that 90% of the quantified proteins had a sample to sample concentration variation below 45%. This variation increased when data for serum samples obtained from 4 different sources were combined. However, the concentration variation of the majority of proteins remained below 60%. Among the proteins that showed a high concentration variation (> 4 times) in serum obtained from different sources, were major components of blood cells, e.g. hemoglobin subunits, platelet proteins, or common proteomics sample preparation contaminants (Keratins).
CONCLUSION: These data demonstrate how robust and precise quantitative low-flow LC-MS/MS serum proteome profiling combined with careful experimental planning may help to avoid identification of false positive biomarker candidates. However, deeper proteome profiling of serum is required to identify biologically relevant drug- or disease-specific biomarkers.
DISCLAIMER: for research use only.


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Development of Laser Assisted Rapid Evaporative Ionization Mass Spectrometry (LA-REIMS) as a Platform for Clinical Microbiology: The Past and the Future

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 15:10

INTRODUCTION: The introduction of MALDI-ToF has reduced the time to identification of microbial isolates. However, it still requires a user to add a matrix to assist in ionisation. Furthermore, in some instances, such as for yeasts, additional extraction steps are required for accurate species level identification. REIMS has previously been demonstrated to provide accurate species-level classification of bacteria and yeasts direct from colonies; without the need for additional preparative steps. In comparison to MALDI-ToF based platforms, REIMS utilises the lipidomic profile of bacteria and fungi to determine their species-level classification without sample preparation which expands substantially the potential application of mass spectrometry to clinical microbiology laboratories.

METHODS: An OmniGuide FELS-25A CO2 laser was incorporated into the TECAN EVO Freedom liquid handling platform previously used for electrical diathermy REIMS. The optimal set-up was previously determined and involves the use of laser power at 2W, using a repeated pulse with intervals of 40 ms and operated in the pulsatile SuperPulse mode. The resulting analyte-containing vapour produced from colony heating is aspirated into a Xevo G2-XS Q-ToF instrument (Waters Corporation, Wilmslow, UK) via a REIMS interface where it is mixed with 2-propanol infused with an external lock mass compound and collides with a heated collision surface prior to entry into the ion guide of the instrument.

RESULTS: This presentation will encompass the on-going work to develop rapid evaporative ionisation mass spectrometry (REIMS) for clinical microbiology. Three main areas will be covered: (1) development of taxonomic identification reference models for bacteria, yeast, and filamentous fungi; (2) quality control and assurance metrics for microbial speciation; (3) determination of antimicrobial susceptibilities; and (4) pathogen detection directly from clinical samples. The results show that REIMS can be used for the direct-from-culture speciation of bacteria, yeast, and filamentous fungi with high accuracy and using an identical workflow to allow easy incorporation into existing workflows. We have also established REIMS-specific metrics with regards to instrument operation, sample acquisition, and data analysis which will be discussed. Further work on extending the application of REIMS to AST and direct-from-specimen pathogen identification will also be shown.

CONCLUSIONS: LA-REIMS offers a novel mass spectrometry platform for clinical microbiology. It is capable of accurate and robust species level identifications for bacteria, yeast, and filamentous fungi directly from culture; employing the same automated, high-throughput workflow for all culture types. In addition, LA-REIMS offers the potential to expand the application of mass spectrometry beyond routine identification, into areas including antimicrobial susceptibility testing and direct-from-sample pathogen detection.


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Therapeutic Drug Monitoring of Clofazimine in Indian MDR-TB Patients

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 11:10

INTRODUCTION: Clofazimine (CFZ) is used as a second line drug for multidrug resistant tuberculosis (MDR-TB) treatment. It exerts slow bactericidal effect on mycobacteria by binding to DNA, leading to cell cycle disruption. CFZ is well absorbed orally with food but has a very long half-life. Its pharmacokinetics (PK) is not well understood especially in drug resistant TB patients where treatment monitoring & adherence play a vital role. There is limited literature on CFZ PK with only 3 - 4 labs testing CFZ drug levels globally. Efficient in vitro and in vivo activities against drug resistant strains and low rates of CFZ resistance have promoted its use in MDR-TB therapy.
OBJECTIVES: The present study aimed to quantitate CFZ levels in patients on ongoing MDR therapy.
METHODS: CFZ quantitation was standardized and validated with a tandem mass spectrometry approach using liquid chromatography mass spectrometry (LC-MS). Plasma samples were deproteinized with organic solvents and analysed on LC-MS from a calibration range of 0.0313-4mg/L. Sparse PK plasma levels (pre-dose and 2 hours post dose) were quantitated on 318 samples from 61 treatment-naive patients with MDR TB. These patients have followed up at months 1, 2, 6, and 12 of treatment respectively. The therapeutic range established in literature for CFZ is 0.5-2mg/L.
RESULTS: The method was validated for linearity, accuracy, precision, recovery, and limit of quantitation and stability. Sixty one patients were assessed with a median age of 26 years (interquartile range [IQR] 19-34), 33% and 67% men and women, respectively, and a median weight of 54.3 kg (IQR 44.7-62.9). All patients were on standard doses of 100mg/day CFZ. Though the pre-dose and 2 hour post dose CFZ levels for most patients were very close, the difference was statistically significant. Significantly low median CFZ levels were observed at month 1 (0.336mg/L, IQR 0.22-0.44) and month 2 (0.453 mg/L, IQR 0.35-0.63) when compared with month 6 (0.728 mg/L, IQR 0.62 – 0.92) and month 12 (0.904 mg/L, IQR 0.78-1.0) of treatment.
CONCLUSION: Therapeutic CFZ levels are attained after 6 months in most patients. Increasing the CFZ dose in first 2 months of treatment till therapeutic levels are attained is worth exploring.
Key words: Clofazimine, Second line anti-TB drug, MDR-TB, Therapeutic Drug Monitoring, LC-MS.


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Metrological Traceability of Lp(a) Requires Defining the Measurand and Introducing Molar Units

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Wednesday at 9:20

Introduction
Lipoprotein(a) (Lp(a)) is a lipoprotein particle that is causally related with atherosclerotic disease, myocardial infarction and aortic valve stenosis. The recent introduction of Lp(a) lowering medication has caused large interest in Lp(a) quantitation. The Lp(a) particle consists of an LDL particle to which an apolipoprotein (a) (apo(a)) protein is covalently bound via a disulfide bridge. Apo(a) contains a number of kringle IV repeats, a kringle V and a protease domain, and varies widely in size due to a size polymorphism in kringle IV-2. The Lp(a) particle holds a lipid core consisting of free cholesterol, phospholipids, cholesteryl esters and triglycerides, apoB and apo(a), and its concentration is traditionally expressed in mass units. Yet, apo(a) size heterogeneity and post-translational modifications such as N- and O-glycosylation of apo(a) affect the molecular mass of Lp(a) particles. We assessed the impact of defining the measurand at the molecular level using bottom-up proteomics, in relation to apo(a) size polymorphism and available PTMs.

Methods
The chemical composition of Lp(a) was assessed through literature study, and the masses of apoB and apo(a) were determined based on their amino acid sequence. A model for the molecular composition of Lp(a) was developed based on the assumption that the lipid composition of the particle is not affected by the apo(a) size polymorphism. The number of kringle IV-2 repeats reported in literature is 3-50, and chemical compositions were calculated for these values. Glycosylation patterns of both apoB and apo(a) were taken into account.

Results
The outcomes of the developed model correspond well with previously reported chemical compositions of Lp(a) [1,2]. An Lp(a) particle containing only three kringle IV-2 repeats per apo(a) is calculated to have a particle mass of 2,767 kDa with a lipid portion of 70% (w/w), apoB of 20% (w/w) and apo(a) of 10% (w/w). However, for a particle containing 50 kringles, the particle mass is 3,639 kDa with a lipid portion of 53% (w/w), apoB of 16% (w/w) and apo(a) of 31% (w/w). The huge mass variation of Lp(a) impedes Lp(a) standardization efforts, whereas molecular characterization of the apo(a) measurand and molar expression of apo(a) content may avert standardization problems.

Conclusions
The expression of Lp(a) particle concentrations in mass units is metrologically inappropriate and should be abandoned. Mass spectrometry using LC-MRM-MS allows molecular characterization of the apo(a) measurand and enables accurate quantitation in molar units, unaffected by the apo(a) size polymorphism and glycosylation. Future traceability of apo(a) to SI units can only be accomplished with an unequivocally molecularly defined protein measurand and the consistent use of molar units [3].

References
1. Kostner et al. J Lipid Res. 1999;40:2255-63.
2. Tsimikas et al. J Clin Lipidol. 2018;12:1313-23.
3. Cobbaert et al. Clin Chem Lab Med. 2018;56:1598-1602.


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Optimization of MALDI-based Techniques for the Rapid Diagnostics of Sepsis

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 14:30

Background
The rapid identification of the causative agent of sepsis is crucial for the patients’ outcome.
MALDI-TOF MS has been shown to be applicable directly to positive blood culture samples.
In this study, we evaluate different MALDI-based approaches for the rapid bacterial identification from blood culture samples. We compared a short subculture-based method with a commercially available lysis-centrifugation method. Further, we optimized the latter to improve its efficacy for challenging-to-identify bacteria.

Methods
In this study, non selected consecutive blood culture samples from the routine were investigated.
N=231 bottles underwent MALDI bacterial identification, in parallel, with short subculture-based protocol (relying on the inoculum of the bacterial pellet obtained from 10 ml of positive blood culture onto chocolate agar, incubated for 1.5 h), and with the commercially available lysis-centrifugation method Sepsityper kit (Bruker Daltonik), relying on the lysis of the blood cells to enable the extraction of the bacterial pellet.
Further N=303 blood cultures underwent the classical and a shortened Sepsityper sample preparation protocol. Another N=3649 samples were processed with a new formulation, to assess performance and robustness of the method.
More, two modified methods were tested to improve the efficiency of identification for Streptococcus pneumoniae (N=21 samples) and Bacteroides fragilis (N=39 samples), two important species for which the standard protocols exhibited a sub-optimal performance.
Results obtained from the positive bottles were compared with the plate subcultures, in terms of correct identification and time-to-reporting.

Results
The lysis-centrifugation method showed a better efficiency than the short subculture method (91.7 % vs 67.3 % correct results), and it enabled to shorten the time-to-report of 2.5-3 hours.
The novel formulation of the kit showed a further improved efficiency (+ 3.6%) in comparison with the old version (from 269/303 (88.8%) to 280/303 (92.4%)) in the comparative study. This test performance was confirmed with the large collection of samples (3289/3649 of identifications – 90.1%).
The dedicated modified protocols enabled to improve the number of correct identifications both for S. pneumoniae (from 19.5% with the shortened method to 71.5%) and B. fragilis (from 35.3% to 89.7%), with the addition of only a 2-minutes step in the protocol.

Discussion
The lysis-centrifugation method proved to be considerably superior than short subculture method for the rapid bacterial identification from positive blood cultures, showing a very good efficacy, and enabling a significantly shorter time-to-report. Further, we showed that with just slight modifications of the protocol, it can be adapted and optimized to succeed in identifying bacteria that are traditionally most difficult to identify directly from the positive blood culture bottles.


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Untargeted Metabolomic Profiles of Newborns that Will or Will Not Develop Autism: A Pilot Study on Dried Blood Spots

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 14:50

INTRODUCTION:
Today autism spectrum disorder (ASD) is diagnosed based on behavioral signs and assessment of communication skills. In this setting, early intervention is a challenge as behavioral signs can be reliably observed only during the first years of life. Whether behavioral impairments are reflected in the blood as biochemical abnormalities is unsure, but the quest for biomarkers is legitimate, as they would represent a useful tool to help in the diagnosis and treatment of ASD and in understanding its underlying molecular mechanisms.
The etiopathology of ASD is indeed still unclear. Main risk factors include genetic and non-genetic factors, especially exposure during fetal life. If the fate of the child is already largely determined at birth, biochemical abnormalities could potentially be detectable very early in life, before behavioral signs can be detected reliably.

OBJECTIVES:
To assess whether there is a marked difference in the metabolome of newborns developing ASD versus healthy controls, we compared metabolomic profiles of newborns who have or have not been diagnosed with ASD at age 7.

METHODS:
Under the iPsych consortium agreement, we randomly selected 37 pairs of matched cases and controls all born in 2005. Cases were subjects for which a diagnosis of ASD was registered in 2012. We performed an LC-MS/MS-based untargeted metabolomics analysis of biobanked dried blood spots, i.e. whole blood collected within the first few days of life for newborn screening purposes. Raw data were preprocessed using Compound Discoverer 2.1 and putatively annotated in mzCloud. followed by multivariate statistical analyses and data visualization, including heatmaps, principal component analysis, partial least-squares discriminant analysis, and paired t-tests combined to fold-change (volcano plots).

RESULTS:
More than 1000 mass spectral features were detected, of which approx. 300 could be putatively annotated based on MS2 fragmentation patterns and library search. Various chemical classes were covered and 15 compounds were identified by comparison with pure standards (amino acids and acylcarnitines). Although the untargeted analysis revealed no clear distinction between cases and controls, we were able to pinpoint mass spectral features differentially abundant in healthy children versus children diagnosed with ASD. Data processing targeting specific subclasses of metabolites will give another perspective on the potential differences between cases and controls.

CONCLUSION:
In this unique study, untargeted metabolomic analysis of the dried blood spots did not reveal significant differences between newborns that have or have not been diagnosed with ASD at age 7. Increasing statistical power, refining selection criteria (subtypes of ASD) and targeting subclasses of metabolites could offer new opportunities to help understand the course of the disease and to contribute to an improved diagnostic process.


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IgG and IgA Glycopeptide Characterization by LC-MS Reveals Associations with Inflammatory Bowel Disease Subtypes and Behavior

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 11:40

Introduction
Inflammatory bowel diseases (IBDs) are prevalent diseases with a high impact on the quality of life of the patients. Causes of IBD are not well understood and the most prominent forms, Crohn’s disease (CD) and ulcerative colitis (UC), are sometimes hard to distinguish. Immunoglobulin (Ig) G and IgA play a prominent role in IBD pathogenesis and their effector functions are known to be influenced by the glycosylation of the constant domain. Here, we developed methods for the site-specific profiling of IgG and IgA glycosylation in plasma and saliva and applied them to study bio fluid-specific antibody glycosylation profiles in healthy volunteers as well as IBD associated changes in IBD patients.

Methods
IgG and IgA were isolated from human plasma and saliva by bead-based affinity chromatography. The purified proteins were digested by trypsin and immunoglobulin subclass-specific glycoprofiling was performed based on the mass spectrometric detection of glycopeptides. IgG and IgA were characterized in 3441 plasma samples obtained from two independent cohorts of patients with CD or UC and healthy controls.
For the saliva-derived IgG and IgA, samples were analyzed from 19 healthy volunteers and comparisons were made between glycosylation profiles from plasma- and saliva-derived antibodies from the same individual.


Results
In patients suffering from IBD, we found lower IgG galactosylation, a well-known marker for systemic inflammation, for different types of IBD as compared to healthy controls. Furthermore, this glycosylation trait was associated with disease severity. Interestingly, the level of various glycosylation features on both IgG and IgA was different between CD and UC. Additionally, we found IgG glycosylation to associate with disease behavior and progression.
The method developed for the analysis of salivary antibodies enabled us to assess the N- and O-glycosylation of all glycosylation sites of both plasma- and saliva-derived IgA, including the one on the joining chain of dimeric IgA. Additionally, for salivary IgA the glycosylation of the associated secretory component was characterized. Salivary IgA exhibited a substantially different glycosylation, as compared to plasma IgA in healthy controls.

Discussion
Based on the differences in antibody glycosylation found between different types of IBD and the associations with disease characteristics, we expect a role for Ig glycosylation markers in IBD classification, the prediction of disease prognosis, and for treatment monitoring.
The characterization of salivary IgA was, as of yet, not applied in disease cohorts. As IgA is a well-known mucosal antibody and we here show bio fluid-specific glycosylation profiles for this protein, we expect the developed method for salivary IgA glycosylation profiling to be particularly relevant for diseases with mucosal involvement, such as IBD and colon cancer.


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Lipidomic Study of Cell Lines Reveals Differences between Breast Cancer Subtypes

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 15:10

INTRODUCTION: Breast cancer (BC) is the most prevalent type of cancer in women in western countries. BC mortality has not declined despite early detection by screening, indicating the need for better informed treatment decisions. It is acknowledged that lipid metabolism is altered in tumours and cancer cells and that the heterogeneity of BC tumour subtypes is reflected in the expression levels of enzymes in lipid metabolism. Therefore, a novel non-invasive diagnostic tool for BC based on lipidomic analysis of plasma samples would allow for subtype-specific treatment and improved prospects for the patients.

OBJECTIVES: The aim of the study was to investigate whether the subtypes defined by the transcriptome are reflected in the lipidome of BC cell lines.
METHODS: BC cell lines representing, tumours positive for estrogen (ER) and progesterone receptor (PgR), CAMA-1, MCF-7, T-47D; HER2 overexpressing tumours, SK-BR-3; and ER, PgR and HER2 negative (triple negative), MDA-MB-231 and MDA-MB-436; were selected as tumour cell lines. MCF10A, a human immortalized mammary epithelial non-cancerous cell line, was used as a reference. The lipidome of human BC cell lines representing different BC subtypes was analysed with an ultra-performance liquid chromatography coupled to a quadruple time-of flight mass spectrometry (UPLC-QTOF-MS) platform. Multivariate data analysis was conducted utilizing principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA).

RESULTS: We identified an increased abundance of triacylglycerols (TG) ≥ C-48 with moderate or multiple unsaturation in fatty acyl chains and down-regulation of ether-phosphatidylethanolamines (PE) (C-34 to C-38) in BC cell lines representing ER- and PgR-positive tumour subtypes. In a BC cell line representing the HER2-overexpressing tumour subtype an elevated expression of TG (≤ C-46), phosphatidylcholines (PC) and PE containing short-chained (≤ C-16) saturated or monounsaturated fatty acids was observed. Increased abundance of PC ≥ C-40 was found in cell lines of the triple-negative BC subtype. In addition, differences were detected in lipidomes within the previously defined subtypes.

CONCLUSION: We conclude that subtypes defined by the transcriptome are indeed reflected in differences in the lipidome and, furthermore, potentially biologically relevant differences may exist within these previously defined subtypes.


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Multidimensional Diagnostics with Machine Learning for Primary Aldosteronism

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 11:20

Background: Mass spectrometric steroid panels have potential for efficient single-sample methods for diagnosis of multiple disorders of steroidogenesis. Moreover within a specific disorder, such methods can facilitate subtyping for more rapid therapeutic intervention than currently allowed. Combined with advances in computational mathematics, such as machine learning (ML), it is now possible to move from traditional uni-dimensional approaches for interpreting diagnostic data to methods that can interpret patterns in multidimensional data.

Aim: Establish an LC-MS/MS based profile of adrenal steroids that with ML can be applied to patients with primary hypertension to first diagnose those with primary aldosteronism (PA) and then further identify patients with adenomas due to KCNJ5 mutations who may specially benefit from surgical intervention.

Methods: LC-MS/MS-based plasma measurements of 15 adrenal steroids were applied to 359 primary hypertensive and 273 patients in who PA was confirmed by conventional diagnostics. Among the latter, adrenal venous sampling enabled identification of 134 patients with bilateral disease and 139 with unilateral disease confirmed by biochemical cure on follow-up after adrenalectomy. Among the latter, 58 had adenomas with KCNJ5 mutations; the other 81 were without KCNJ5 mutations. A series of nine ML algorithms and 12 different batch corrections, data normalizations and feature selection rules was applied in 10-fold cross-validation steps to establish optimal models for multiclass classification of patients with and without PA and in the former the presence of unilateral disease due to KCNJ5 mutations.

Results: After adrenalectomy, patients with adenomas due to KCNJ5 mutations exhibited both higher (P<0.01) rates of biochemical cure and reductions of blood pressure than those without mutations. According to logistic regression a selection of steroids performed similarly to routine aldosterone:renin ratios for diagnosis of patients with PA, but showed superior (P<0.005) discrimination of patients with unilateral disease. With a random forest model, initial screening for PA could be achieved at over 80% sensitivity and close to 100% specificity. On the other hand, models involving support vector machine with non-linear kernel and recursive feature elimination provided optimal identification of patients with adenomas harboring KCNJ5 mutations (>92% sensitivity, >95% specificity) and reasonable screening of patients with PA (>75% sensitivity, >95% specificity).

Conclusion: Mass spectrometry-based steroidomics provides an ideal platform for advancing multi-dimensional approaches for disease diagnosis, in this particular study directed to PA. With such approaches it should be possible to more efficiently and effectively both diagnose patients with disorders of steroidogenesis and stratify them for effective therapeutic intervention.


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Assessing the Metabolome of Preterm Newborns: Findings from a Danish Population-based Study

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 14:30

INTRODUCTION:

Approximately 15 million babies worldwide are born preterm every year, and 1 million thereof die due to complications. The number of preterm birth, that is a baby born alive before 37 weeks of gestational age is constantly rising, and although some causes such as infections, diabetes or high blood pressure are known, the cause of a spontaneous preterm birth remains often unknown. A better understanding of the underlying metabolomic changes in preterm neonates could aid the development of solutions to prevent it as well as foster more feasible care and treatment options.

OBJECTIVES:

The objective of this study was to assess how the neonatal metabolome varies with gestational age and to investigate whether and how the metabolomic profile of preterm newborns differs from that of healthy term infants.

METHODS:

We used liquid chromatography tandem mass spectrometry (LC-MS/MS) in combination with metabolome mining tools, such as mass spectral molecular networking (GNPS), unsupervised substructure discovery (MS2LDA) as well as in silico annotation tools to assess the metabolomic profile from dried blood spots from over 300 neonates with varying gestational ages and health statuses sampled from the Danish National Biobank resource.

RESULTS:

We assessed the blood metabolomic profile and identified metabolites significantly varying across gestational age and with known effects also in disease etiology, such as for example bile or amino acids. Furthermore, metabolome mining tools, such as mass spectral molecular networking were revealed as powerful resources to differentiate molecules and drug metabolites from molecules likely originating from contaminating sources.

CONCLUSION:

In this study we could show that there are distinct metabolic features that vary with gestational age and that mass spectral metabolomics analysis of dried blood spots is a powerful tool to assess the metabolome of preterm neonates. With over 2 million dried blood spots, the Danish National Biobank is an exceptional resource for future large-scale integrated omics studies not only in the context of preterm birth but also for the investigation of other inborn diseases.


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Comparison of MRM- and DIA-based Protein Quantification Using a 500 Protein Blood Panel in Plasma Samples Demonstrates Linearity between Methods

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 9:10

Background
Monitoring of circulating protein biomarkers in plasma has utility for early detection, differential diagnosis, predicting response to therapy and treatment monitoring. SRM/MRM based methods have been the mass spectrometric (MS) platform of choice for low to mid multiplexed protein quantification in biological samples. Recently, data-independent acquisition (DIA) MS has emerged as technology for label-free quantification of very high numbers of proteins. To evaluate the quantification of proteins from DIA data with respect to the comparator method (MRM), we evaluate a mixed plasma sample set (lung cancer, pancreatic cancer and normal controls) with a panel of stable-isotope standard (SIS) peptides for linearity and reproducibility.
Methods
Plasma samples from subjects with non-small cell lung cancer (NSCLC, n = 15), pancreatic cancer (PC, n = 6) and healthy donors (n = 15) were processed to peptides and prepared for mass spectrometry. Prior to analysis, PQ500, a panel of SIS peptides covering 582 plasma proteins (804 peptides), was spiked into each sample enabling absolute quantification of detectable peptide species. The entire sample set was analyzed twice. DIA data were acquired using 40-minute gradients on a C18 capillary-flow liquid chromatography column (5 µl/min) coupled to a Thermo Scientific Orbitrap Fusion Lumos mass spectrometer operating in DIA acquisition mode. MRM data were acquired using similar capillary-flow liquid chromatography (5 µl/min) with a one-hour linear gradient coupled to a Thermo Scientific TSQ Altis triple quadrupole mass spectrometer. Target to reference ratios for the data acquired with the two methods were compared and evaluated for linearity over the sample set.
Results
Due to the sample pathology, multiple acute phase reactants (e.g. CRP and SAA1) have significant dynamic ranges across the sample set (1.5 – 2.5 orders of magnitude). When evaluated for linearity CRP displayed excellent concordance for two unique peptides which were quantified with R2 values of >0.91. A similar evaluation was performed for all peptides that were quantified.
Conclusions
For plasma proteins with significant dynamic ranges of expression in the plasma sample set, a high degree of correlation is observed between DIA and MRM based quantification. The data suggests that the quantitative properties of DIA are comparable to targeted MS methods while providing a high degree of multiplexing for unbiased exploratory studies in clinical samples.


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Determination of D- and L-Lactic Acid in Urine by UPLC-MS with Electrospray Ionization Quantification

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 15:45

Introduction: Lactic acid is an organic acid found in two enantiomeric forms: the L- and D-lactate stereoisomers. D-lactic acid is produced from bacteria inhabiting the gut and also from mammalian methylglyoxal metabolism. In humans, the majority of systemic D-lactate is derived from the bacterial metabolism of carbohydrate in the upper GI tract. In pathological states, intestinal permeability is increased elevating the uptake of bacterial D-lactate from the gut. Circulating D-lactate concentrations may therefore provide a useful diagnostic tool for bacterial infections, gut permeability and GI health and disease.
Many studies show significant concentrations of D-lactate in the urine with potential to reflect an overload or fluctuations due to pathologies. However, a huge variation in the concentrations are reported depending on the analytical method used. Existing methods also lack sensitivity and due to demands for prior sample clean-up steps or sample derivatization are not sufficiently high-throughput to assess large sample sets. Determining the physiological significance and diagnostic value of urinary D-lactate requires a sensitive high-throughput analytical method to generate large-scale data to correlate with pathophysiological conditions. Here, we have optimized a sensitive and specific method to fulfil both requirements to investigate D-lactate concentrations following different types of enteric infections in infants.
Methods: The assay was developed from the method of Henry et al. (2012) using 170 urine samples that were processed without derivatisation or dilution. Samples were vortex-mixed, centrifuged at 4°C to remove debris and 500 μL aliquoted into vials. Isotopically labeled internal standards sodium d4-D/L lactic acid and 13C-L-lactic acid were spiked before injecting onto a Waters Acquity UHPLC solvent management system. Chromatographic separation was achieved by the use of an Astec Chirobiotic™ R chiral column under isocratic conditions using 15% (v/v) 33.3 mMol/L ammonium acetate in H2O and 85% (w/w) acetonitrile. MS detection was performed with a Waters Xevo TQ-S tandem quadrupole instrument using negative electrospray mode.
Results: The lower limit of quantification of D-lactic acid was 0.0005 mMol/L for D-lactate and 0.001 mMol/L for L-lactate. Calibration curves were linear over the ranges of 0.001–0.4 for L-lactic and 0.0005–0.1 mMol/L for D-lactic acid. The mean nominal concentrations were 0.006526 and 0.060077 mMol/L respectively for D- and L-lactic in samples.
Discussion and Conclusions: Following optimization this UPLC/MS approach for D-lactate determination is suitable for large-scale epidemiological research, reporting very low quantification limits. The protocol was successfully applied to a human infant cohort and on-going analysis is being performed to validate the method and investigate the biological significance of urinary D-lactate with intestinal infections and gut permeability status.


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The Harmoster Initiative: Preliminary Results on the Comparability of Circulating Steroid Measurement Among Ten European Laboratories Using LC-MS/MS

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 11:00

Background. LC-MS/MS is recommended for circulating steroid measurement, as its intrinsic specificity is supposed to guarantee accurate quantitation. LC-MS/MS also represents a promising opportunity to achieve harmonization of steroid measurements. However, LC-MS/MS assays applied in different laboratories use various pre-analytical and analytical approaches that may influence assay performance and final result. So far, little data have been generated on the comparability of LC-MS/MS steroid measurements.
Objective. To compare the LC-MS/MS measurement of 13 circulating steroids among 10 European centers operating in clinical and research settings.
Methods. Blood from 13 women and 13 men aged 21-70y was collected in fasting state, at 8:00-9:00 am, after 10 min saline infusion in three different vacuum tubes to obtain serum (gel separator, GS and beads) and plasma (Li-Heparin). Each center received two aliquots of 78 total samples for LC-MS/MS steroid measurement according to the lab’s own procedure. Intra-lab duplicate measurement CV%, inter-lab CV% and Bland-Altman analyses were performed.
Results. Preliminary results from six labs were obtained on cortisol (F), cortisone (E), corticosterone (B), 11deoxycortisol (11S), 17OH-progesterone (17OHP4), androstenedione (A4), testosterone (T) and DHEAS. Most of intra-lab imprecision was <10% for all analytes, with some exceptions <20%. Inter-lab CV% per sample ranged 6.6–31.4% for F, 1.6–16.4% for E, 1.4–34.5% for B, 4.3–39.5% for 11S, 2.3–35.4% for 17OHP4, 2.8–16.9% for A4, 2.4–13.2% for T and 1.0–16.6% for DHEAS. Cases showing inter-lab CV>15% were 0 for T; 1 (1.3%) for E and DHEAS; 3 (3.8%) for A4; 13 (16.7%) for B; 25 (32.1%) for 17OHP4; 36 (46.2%) for 11S and 42 (53.8%) for F. Among GS-sera, cases increased to 18 (69.2%) for both 11S and F. Laboratory mean bias vs all-lab median values ranged -3.5 – 5.8%, -1.9 - 6.5%, -3.2 – 9.1%, -16.5 – 14.6% and -5.0 – 36.9% for DHEAS, E, A4, 11S, and F, respectively. Moreover, mean bias ranged -12.3 – 10.6% and -4.7 – 12.9% for B <10ng/mL and >10ng/mL, respectively, -23.4 - 7.5% and -6.7 - 4.7% for 17OHP4 <1ng/mL and >1ng/mL, respectively, and -2.9 – 6.4% and -8.5 – 8.7% for T <1ng/mL and >1ng/mL, respectively.
Conclusions. Variable intra-lab performances were observed. Inter-lab comparability was good for E, DHEAS, A4 and T, while improvements are needed for F, 11S, B and 17OHP4 measurement. Variability in B and 17OHP4 measurement increased at lower levels, while the opposite was observed for T. The specimen type may have an influence on results. Further analyses are required to define major sources of variability.


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Development of an Immunoprecipitation Method for the Analysis of Intact Parathyroid Hormone (PTH) and Related Forms by LC-MS/MS

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 11:00

INTRODUCTION:
Parathyroid hormone measurement has faced cross-reactivity issues ever since the first assays were developed. Multiple hormone fragments found in the body hamper the specific measurement of clinically relevant forms when using immunoassays. Therefore, the use of LC-MS/MS techniques could provide the required specificity for unequivocal PTH analysis as has recently been demonstrated by some published methods, which rely on immunoprecipitation of the analyte followed by a tryptic digestion step.
Considering the length of the whole PTH (84 amino acids) and its molecular weight of 9425 Da, an intact protein analysis seems a practicable approach as described in the present project.

OBJECTIVES:
The aim of this work was to develop a method to quantify intact PTH hormone, including its oxidized forms by LC-MS/MS, capturing the compound with antibody coated magnetic beads. Other PTH fragments are also in the scope for further project development.

METHODS:
Proposed sample preparation
Sample preparation was performed by means of immunoprecipitation by magnetic beads coated with protein G. Beads were initially washed three times in a 1.5 mL vial with a 0.1% solution of PBS-Tween 20 (Washing solution), then 200 µL of a 5 µg/mL solution of monoclonal antibodies (targeting C-terminal PTH) was added and incubated together with the beads for 10 min at room temperature prior to a three times wash. 500 µL of sample was added to the beads, incubated for 1h at room temperature and washed once. Finally, the captured analyte was eluted with a solution containing 50% acetonitrile and 0.5% formic acid. The eluate was evaporated in a SpeedVac, reconstituted in 10% acetonitrile and 0.01% formic acid and further injected to a Nexera X2 ultraperformance liquid chromatography (UHPLC) coupled to a Sciex QTRAP® 6500 triple quadrupole MS/MS in positive electrospray mode.
RESULTS:
Preliminary results
Plasma free samples spiked with intact PTH to a concentration of 500 pg/mL gave intense peaks in the range of 105 counts per second with a very low background noise. Signal-to-noise ratio (S/N) for these samples was calculated 600. Other forms of PTH such as 7-84 and 1-84 oxidized forms were also isolated and successfully analyzed by means of this technique.

CONCLUSION:
This innovative intact immunoprecipitation LC-MS/MS approach could provide the required selectivity to unambiguously quantitate PTH and some of its truncated forms. The good response found in the preliminary results suggest the suitability of the method for low concentrated samples, as they are found in the body.


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Metabolomics Analysis of Blood Plasma for Early Diagnosis of Uterus Leiomyoma Recurrences

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 11:00

INTRODUCTION: Uterine leiomyoma is one of the most frequent gynecological pathologies in women before the menopause. Despite numerous studies of factors involved in the genesis and growth of uterine leiomyomas the causes of uterine fibroids, as well as its recurrence are still the subject of discussion. It is of great interest to develop new noninvasive methods of early diagnosis of uterine leiomyomas and its recurrences using highly informative modern techniques such as mass spectrometry. Early prediction of leiomyoma recurrence will assist the patient and her gynecologist in deciding the most appropriate method of treatment.
METHOD: The study included 35 women with newly diagnosed uterine leiomyomas and 31 women diagnosed with recurrent uterine leiomyomas, who were examined and operated in the Department of a Gynecologic Surgery at V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology. Uterine fibroids were diagnosed by vaginal examination, ultrasound data, confirmed laparoscopically, and finally verified histologically. Lipid composition of samples was determined by LC- MS/MS analysis using Maxis Impact qTOF mass spectrometer. Multivariate data analysis of the MS data was performed with principal components analysis (PCA) to detect outliers, and partial least squares-discriminant analysis (PLS-DA) with Pareto scaling using “ropls” library to find out if the MS data was sufficient for the classification of samples under the study.
RESULTS: Blood plasma from 66 women with leiomyomas and 15 women of control group were investigated by the ESI-MS method to obtain information about molecular composition. Among all detected metabolites, 267 significant lipid peaks were identified and divided into five different classes: phosphatidylcholines, phosphatidylethanolamines, sphingomyelins, di- and triglycerides. The identification was provided according to accurate mass within 10 ppm mass accuracy. MS/MS information about the fragmentation pattern was used for better peak assignment. Based on semi-quantitative data on the level of potential lipid biomarkers in the blood plasma, OPLS-DA models were developed to classify patients. Analysis of plasma lipid composition in patients with leiomyoma and leiomyoma recurrences, and patients without uterine fibroids revealed a number of phospholipids, sphingomyelins, cholesterol esters and triglycerides, the levels of which differ significantly in blood plasma. The lipids test panel was suggested for early diagnosis of uterus leiomyoma recurrences.
CONCLUSION: A comparative study of the mass spectrometric profiles of blood plasma allows us to identify new molecular markers for early diagnosis of uterus leiomyoma recurrences. In the future, the results of our research will be used to determine the optimal treatment strategy for patients with uterine leiomyoma, and will lead to the creation of new prognostic strategies and therapies.


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C-20 Hydrogenation is Involved in Intrauterine Cortisol Homeostasis Offering an Additional Sex-Driven Protection to Prenatal Stress. Implications in Birthweight

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 13:55

Introduction: Fetal sex has effects on prenatal stage, being male fetuses more prone to maternal stress than females. Fetus is protected from maternal cortisol by placental 11βHSD2 (by conversion to cortisone) and other enzymes that might inactivate cortisol into its metabolites. The effect of fetus gender on protection against maternal cortisol remains unexplored.
Objectives: The aims of this study were (i) to evaluate sex differences in cortisol inactivation and metabolism in the feto-placental unit, (ii) to set a metabolic fingerprint of prenatal stress by biological stressors and (iii) to correlate the metabolic fingerprint with birthweight.
Methods: A LC-MS/MS targeted metabolomics approach was used to determine cortisol, cortisone and 10 of their metabolites in amniotic fluids collected at term after cesarean delivery (n= 40, 19 females, 21 males) and after vaginal delivery (n= 49, 25 females, 24 males). We determined metabolite concentrations, metabolite ratios to evaluate enzymatic activity (e.g. 11βHSD2) and the percentage of cortisol excreted as each metabolite. We evaluated sex differences in cortisol inactivation and metabolism by comparing the steroid profile after cesarean delivery. The metabolic fingerprint of prenatal stress for both sexes was obtained by comparing cesarean (non-stressful) vs vaginal (stressful) delivery. Finally, we evaluated correlations between the metabolic fingerprint and birthweight.
Results: Our results show sex differences in cortisol metabolism. Under non-stressful conditions, female fetuses show a 21% higher activity of 11βHSD2 (p= 0.034). Contrarily, male fetuses show an increase for some cortisol metabolites e.g. 31% higher conversion to 20βDHF (p= 0.022). Sex-specific metabolic fingerprints were found after prenatal stress. Males showed a 21% decrease in 11βHSD2 (p= 0.012). Females also exhibited an increase of 40% and 30% in the percentages of 20αDHF (p= 0.039) and 20βDHF (p= 0.020) respectively. Finally, the prenatal stress metabolic fingerprint positively correlates with birthweight in males (r = 0.442, p= 0.045 for cesarean and r = 0.483, p= 0.017 for vaginal). In females metabolic fingerprint is negatively correlated (r = -0.450, p= 0.046) only in cesarean delivery.
Conclusion: Our targeted metabolomics results provide robust evidence about sex differences in the prenatal inactivation of maternal cortisol. Thus, in non-stressful conditions female fetuses are more protected by 11βHSD2 whereas protection in males is mainly performed by cortisol conversion into C-20 reduced metabolites. Females seem to use the C-20 hydrogenation pathway as an alternative under stress, suggesting a better adaptation to prenatal insults. The metabolic fingerprint of prenatal stress negatively correlates with birthweight for females and positively for males. Our results provide new insights about sex-differences in cortisol metabolism and might explain the different sex adaptation to prenatal exposures.


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LC- and CE-MS-based Workflow for Metabolic Read-Across of New Toxicants in Neuroinflammation

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 13:15

Introduction: Risk assessment of new or existing chemicals finds a bottleneck in the evaluation of their potential as toxicants. Current approaches are too resource intensive in terms of time, money and animal use, thus limiting the number of substances which can be assayed. Chemical risk assessment using in vitro biological models such as human cell cultures allows to increase throughput while reducing cost and animal use. In such models, untargeted metabolomics can unveil triggered adverse outcome pathways (AOP) without the need for previous hypotheses.
Objectives: Our goal was to use a metabolomics strategy to highlight metabolic changes taking place in human astrocytes as a cost-effective model to study toxicant-induced neuroinflammation before the actual clinical effects become manifest. Since different substances will trigger this process through different AOPs, each one will provide a characteristic metabolic fingerprint. By comparison to the signature obtained for model toxicants, the neuroinflammatory potential of new chemical entities can be predicted without the need for animal testing.
Methods: Monolayer human astrocyte cultures derived from induced pluripotent stem cells (iPS) were exposed to different model neuroinflammatory substances at different doses. With the aim to enlarge the biochemical information recovered from the samples, a combination of three different liquid-chromatography methods and two capillary electrophoresis modes were coupled to high-resolution mass spectrometry detection. By using in-house developed software and reference databases, data pretreatment and metabolite identification were streamlined. Finally, multivariate analysis (MVA) allowed to cluster toxicants and doses according to the induced biological responses.
Results: MVA analysis successfully clustered the samples according to the indentity and concentration of the applied substances. The control group is noticeably separated from the treated ones. Interleukin 1β at low dose shows a characteristic profile, while low doses of other cytokines tend to have a comparable effect on metabolic patterns. Interestingly, all the cell samples show a similar behavior when exposed to high doses of the tested substances. Such a convergence phenomenon suggests that subtle metabolic differences in early-stage or mild neuroinflammation can progress towards a stronger and less specific metabolic shift. Pathway enrichment tools were used to evidence the nature of the metabolic alterations observed.
Conclusion: We developed a new workflow comprising a panel of analytical platforms, data treatment steps, and data interpretation allowing to characterize the metabolic changes induced by neuroinflammatory triggers on human astrocyte cultures. This approach paves the way to a mid-throughput chemical risk assessment strategy not relying on animal models and allowing to foresee the expected toxicological mechanism of a new substances depending on the metabolic pattern..


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Exploring the Interactions between Dietary Polyphenols, the Gut Microbiome and Human Health

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 9:10

Introduction:
Epidemiological and dietary intervention studies suggest that consumption of polyphenol-rich foods may have a number of health benefits, including reduced risk of cardiovascular disease. Increased intake of polyphenols, found at high levels in tea, fruit and vegetables, has been associated with health-promoting benefits including vascular and platelet function, blood pressure and improved plasma lipid profile. However, the mechanisms behind these benefits remain unclear, and the bioavailability of dietary polyphenols is highly variable between individuals. A significant fraction of dietary polyphenols can persist in the colon, where they are exposed to the gut microbiota. Since the study of the human gut microbiota is hindered by the complexity of this ecosystem and accessibility, in vitro gut models provide a powerful tool to build mechanistic knowledge around microbial polyphenol bioconversion.

Objectives:
The primary objective of this study was to understand the involvement of human microbiota in the metabolism of different plant polyphenol substrates using an in vitro. This approach enables investigation of broad metabolite perturbations and variations in microbial diversity to enhance mechanistic understanding of polyphenol bioactivity and nutritional influences to improve health through diet.

Methods:
Fermentation studies were performed using a three stage in vitro gut model with human stool from three donors, incubated in the presence of four different flavanol-containing substrates (Byrsonima intermedia, Rhizophora mangle, Serjania marginata and Theobroma cacao extracts). Samples were taken at ten time points over a 48-hour period (0, 1, 2, 3, 4, 5, 6, 8, 24 and 48 hrs).

Untargeted and targeted LC-MS metabolite profiling was applied to explore polyphenol metabolism and the influence on gut microbial activity.

Results:
Distinct metabolic differences were observed in the in vitro culture profiles in the presence of polyphenol substrates. Multivariate statistical analysis using principal components analysis (PCA) demonstrated variations in the metabolites produced by the different polyphenol extracts in a time dependent manner. Univariate analysis showed the magnitude of change between microbial metabolites and highlighted interindividual differences in metabolism, as well as changes in endogenous compounds in response to the polyphenol substrates. Targeted LC-MS/MS methods were also applied to profile phenolic, bile acid and short chain fatty acids to gain a deeper understanding into the potential mechanism of bioactivity of dietary polyphenols.

Conclusion:
The combination of untargeted and targeted LC-MS methods allowed for detailed exploration of gut microbial metabolism of plant polyphenols, providing an in-depth workflow to determine the bioconversion of dietary polyphenolic compounds.


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Assessing the Quality and Robustness of LC-MS/MS Assays

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Thursday at 10:30

Here I will be presenting three tracks that will hopefully help new users improve the quality and robustness of their assays.

During the first track I will discuss identifying and troubleshooting poor chromatography, peak integration and the use of techniques to help identify potential interferences and thus improve the confidence in results.

The second track will concentrate on strategies that can be used to help assess method robustness. Here I will look to highlight the importance of all the data that is available aside from the final result. We will cover what data can be routinely recorded (e.g. top standard areas/heights, retention times, peak widths etc) and why that may be useful in helping troubleshoot assays and identify issues.

The third track will address reagent control, specifically aimed at a implementing and managing a system that is ISO 15189 compliant. I will discuss acceptance testing of reagents including calibrators, QCs, internal standards, routine mobile phases and any reagent used in sample preparation

By the end of the session you should have improved ability to identify and troubleshoot problems, understand how data can be used to assess assay robustness and be able to implement and manage a ISO 15189 compliant reagent control system.


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VOC-based Real-Time Breast Cancer Diagnostic Using LTP-MS

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 9:20

INTRODUCTION: Early diagnosis is central in cancer care since it is directly related to the prognostic, evolution and survival of patients. For instance, the 5-year survival rate for breast cancer (BC) drops drastically if the pathology is diagnosed at a later state, from 80% at stage II to 22% at stage IV for metastatic cancer.
Analysis of Volatile Organic Compounds (VOCs) is a promising approach for achieving accurate and non-invasive molecular classification of cancer. VOCs analysis from exhaled breath and body fluids. These volatilomic studies are mainly based on desorption tube (TD) coupled mass spectrometry (MS) through gas chromatography (GC). However, these strategies are time consuming with many steps of sample handling. Low temperature plasma (LTP) is an ambient ionization mass spectrometry ion production source allowing the real-time analysis of VOCs from surfaces and complex matrices without any prior sample manipulation. Moreover, LTP-MS enables the ambient soft ionization and desorption of molecules from solid, liquid, and gaseous materials.
OBJECTIVES: The main objective was the development of a LTP-MS system for the real-time diagnosis of BC based on VOCs signature. The first goal was the discrimination of three BC cell lines (SKBR3, MCF7, MDA) according their VOCs signature using Tenax disc as sorbent membrane. The second objective was the application of the developed LTP-MS system to study the VOCs from the skin of BC and healthy patients. Additionally, the method was also applied on dogs and cats suffering from mammary cancer.
METHODS: To capture VOCs from cell culture, a dynamic headspace sampling was performed on cell in media during 30 minutes at 37°c in a 2ml glass vial. For the VOCs analysis from skin patients, the membranes were incubated overnight directly at the surface of the breast. After VOCs collection, all the membranes were analyzed by the developed LTP-MS system composed as follow: a membrane thermal desorption chamber and a sweep gas to carry the desorbed VOCS to the LTP probe positioned at the inlet of a mass spectrometer. The enriched VOCs gas are directly ionized by the LTP for their detection and their analysis. The data were then statistically analyzed by Model builder (waters).
RESULTS: The build principal component analysis model of VOCs from cell culture was based on 50 burns, cross validation were done to validate the model (90.11%). This model allows the discrimination up to 70% with 2 components of cells line. This LTP-MS system allow the discrimination of VOCs from cell culture.
For the patient discrimination, the model were built as previously described. The two first component explained at 85% the difference between the two groups (healthy and not). This model discriminated the Breast or mammary cancer with healthy patient.
CONCLUSION: VOCs can be used as a signature of cancers and coupled to a LTP-MS technology, it allows a non-invasive real time diagnosis of patients.


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Volatile Organic Compound (VOC) Profiling in Liver Disease via Selected-Ion Flow-Tube Mass Spectrometry (SIFT-MS)

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 9:40

INTRODUCTION:
Chronic liver disease and cirrhosis are associated with significant morbidity and mortality and represent a major burden to health services. Multiple underlying aetiologies, unclear diagnostic pathways and late presentation of clinical signs are all challenges to improved detection and management of liver disease. The detection of volatile organic compounds (VOCs) in breath by mass spectrometry has the potential to discriminate between healthy controls and patients with liver disease.

OBJECTIVES:
The primary objective of this study is to measure the VOC profile of patients with liver disease via selected-ion flow-tube mass spectrometry (SIFT-MS).

METHODS:
Patients attending St Mary’s Hospital for hepatology investigations or follow up were invited to participate in this study. Patients having an ultrasound were required to be fasted for a minimum of 4 hours prior to the scan and any patients who had not been fasted had a food diary taken for the preceding 12 hours. Patients were asked to provide six tidal exhalations into the heated inlet of the SIFT-MS instrument (Syft Voice200ultra). This method permits real time quantification of selected VOCs via direct injection. VOCs previously identified as being significantly different in liver disease were selectively analysed. Patients were then divided into four categories on the basis of their pre-existing pathology or radiology results: (i) healthy, (ii) healthy with risk factor for liver disease (e.g. viral hepatitis), (iii) fibrosis and (iv) cirrhosis.

RESULTS:
41 participants were recruited (34 male; median 54.5 years, range 24-81 years): 6 healthy, 15 with risk factor for liver disease, 7 fibrosis patients and 13 cirrhotic patients. There was a significant difference in the levels of nonanone (0.40ppb vs. 0.78ppb) and octanone (1.02ppb vs. 1.78ppb) between healthy controls and cirrhotic patients. Limonene was significantly higher in healthy controls with risk factors compared to cirrhotic patients (4.40ppb vs. 8.80ppb). Propanol was significantly higher in both healthy controls and healthy controls with risk factors compared to cirrhotics (80.55ppb vs. 67.20 ppb vs. 33.38 ppb) . When only including patients that had fasted, the variability was reduced across all cohorts.

CONCLUSION:
This data set raises the possibility that VOC profiles in breath could be used to discriminate between healthy and diseased livers and form the basis of non-invasive screening test. Further work needs to be done to standardise breath testing including consideration of dietary exclusions prior to undertaking breath analysis via mass spectrometry.


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Traceable Clinical Measurement

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Wednesday at 11:00

This is a practical training session describing the process of certifying traceable reference materials and/or traceable reference values of analytes in a clinical matricies, with a defined uncertainty. This work is routinely carried out at the NML to provide traceable values to materials listed on the JCTLM database, and also to provide traceable reference values to clinical materials.
The workshop will include descriptions of optimisation of measurement, traceability, uncertainty and example workflows for targets such as creatinine, immuno-suppressants (sirolimus and tacrolimus) and metanephrines. It is hoped participants will gain an insight into the work of the NML and the requirements for traceable clinical measurement. There will also be a brief discussion at the end of the workshop on the requirements for future materials.

3 take home pearls
How to maintain traceability to the SI in clinical reference measurement
Uncertainty calculations for traceable measurement
Examples of pitfalls encountered during the certification process


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Development and Validation of a Gas-Chromatography Mass Spectrometry Method for the Analysis of Testosterone Esters in Biological Matrices

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 9:00

Introduction
The detection of doping by testosterone (T) and its precursors is currently based on the evaluation of the so-called “urinary steroid profile”. Abnormal alterations of one or more of its parameters might indicate the misuse of T and/or related steroids and trigger subsequent confirmation analysis, by gas-chromatography coupled to isotopic ratio mass spectrometry (GC-c-IRMS), to assess the difference between the 13C/12C ratio of synthetic and endogenous T and its precursors/metabolites
In recent years, some Authors have reported the occurrence of T preparations displaying a carbon isotopic ratio very similar to the range reported for the endogenous urinary steroids. For this reason, the detection of intact T esters (in blood, plasma or serum) would be an unequivocal proof of the intake of exogenous T
Objective
The aim of the present work was to develop and validate a gas-chromatography tandem mass spectrometry (GC-MS/MS) method for the detection of fourteen T esters (acetate, propionate, valerate, isocaproate, caproate, benzoate, hexahydrobenzoate, enanthate, cypionate, octanoate, decanoate, phenylpropionate, undecanoate, laurate) in plasma and/or serum. For indeed, the presence in blood/plasma/serum of an intact synthetic T ester represents an unequivocal proof of the exogenous origin of the steroid.
Methods
After liquid-liquid extraction at pH 9 (carbonate buffer 20% w/V) with n-hexane/ethylacetate (70/30 V/V) all plasma/serum samples were analyzed by GC-MS/MS with electronic impact (EI) source and multiple reaction monitoring (MRM) acquisition mode. T esters were revealed as trimethylsilyl derivates.
Results
Qualitative validation of the method was carried out for all the T esters mentioned above. The folllowing parameters were considered: specificity, selectivity and limit of detection (LOD). The method was shown to be specific and selective for twelve out of fourteen T esters, with LODs between 0.1 and 0.2 ng/mL.
Quantitative validation was also carried out, for the five T esters (propionate, enanthate, cypionate, phenylpropionate, undecanoate) that are present in most of the pharmaceutical preparations reportedly abused by athletes. Considered parameters were the following: specificity, selectivity, LOD and limit of quantification (LOQ), recovery, linearity, repeatability and accuracy. All T esters could be determined with a combined uncertainty smaller than 20% and the calculated LODs and LOQs appeared to be adequate for the detection of the compounds over the range of concentrations corresponding to a potential alteration of the parameters of the urinary steroid profile.
Conclusions
The method here presented is specific and selective for twelve T esters and fully satisfies the WADA identification criteria for the identification of analytes for doping control purposes. The presented method can also be used to confirm the composition of seized pharmaceutical preparation by responsible authorities.


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Development of an LC-MS/MS Assay for Biotin Quantitation to Support Research on Biotin Interference of Immunoassays

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 14:30

Background: Recent studies have shown that the results of immunoassay methods, using streptavidin-biotin interaction methodology, can be affected by the presence of high biotin circulating levels due to supplemental therapy leading to a growing number of adverse events. The evidences so far reporting on biotin interference by immunoassay methods are mainly based on case reports, rather than on experimental or clinical studies.
Aim: We developed an LC-MS/MS method for measuring biotin in serum to support research on biotin interference of immunoassays.
Methods: Samples underwent trichloroacetic acid precipitation prior to chromatography using a ACQUITY BEH C18 1.7 μm, 2.1 x 50 mm Column (Waters) with gradient elution. Mobile phases A and B consisted of ammonium bicarbonate (10 mM, pH 8.75) and MeOH (100%), respectively. Purified biotin, >99% purity (Cat. No. PHR1233, Sigma-Aldrich), and its deuterated internal standard, biotin-d4 (Sigma-Aldrich) were used to establish a 5-point calibration curve (range: 0-1315 ng/mL). Fragments of biotin and biotin-d4 were detected using positive ESI (Xevo TQS, Waters) by SRM using m/z 245.0>226.9 (96.9 qual.) and 249.0>230.9, respectively. Method accuracy was verified using a biotin European Pharmacopoeia Reference Standard (Sigma-Aldrich).
Results: The limit of quantitation was 1 ng/mL (20% CV), and inter-run precision was <10% at 10 ng/mL and 100 ng/mL. On the basis of our LC-MS /MS measurements, we noticed discrepancies in the magnitude of observed immunoassay interference between patient sera following biotin supplementation and when the same amount of biotin was spiked to blank serum. This indicates that not only free biotin but also biotin metabolites (e.g. biotin sulfoxide and bisnorbiotin) are likely to contribute to immunoassay interference, an issue not always accounted for in manufacturer-established thresholds (often based on exogenous addition of pure biotin).
Conclusion: Our LC-MS/MS assay will allow for more precise data of biotin prevalence, serum biotin interference and better understanding of the systemic concentrations seen after moderate- and high-dose biotin supplementation.


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High-Throughput Analysis on FFPE Breast Cancer TMAs with DESI-MSI

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 14:30

Introduction: Today, most pathological tissue samples are stored as formalin-fixed paraffin embedded (FFPE) tissue blocks, which is the gold standard for histopathological analysis. This form preserves the tissue very well as formalin fixation forms methylene cross-bridges between proteins. Additionally, by paraffin embedding the tissue it allows for indefinite storage at room temperature so there are a number of large FFPE tissue archives around the world. Tissue microarrays (TMAs) is one of the most important forms of FFPE categories. TMAs are blocks that contain tissue cores from multiple sources in an array which allows for high-throughput analysis of many tissue samples. Mass spectrometry imaging (MSI) is a powerful tool that enables us to investigate the regional distribution of a variety of molecules in biological samples. It is crucial to have knowledge of the spatial distribution of biomolecules to understand the biological processes that take place within the tissues. Desorption electrospray ionization mass spectrometry imaging (DESI-MSI). particularly suited to investigate the spatial distribution of metabolites. Metabolite measurements are growing in importance as altered metabolism is a hallmark of many diseases, such as cancer. Currently, fresh frozen (FF) samples are preferred over FFPE samples in tissue based MSI studies. This is primarily due to the concern that small molecules will be lost during fixation and chemical processing as well as the belief that that paraffin will cause ion suppression.
Methods: Breast cancer tissue was obtained from approximately 30 breast cancer patients undergoing mastectomy as well as normal control tissue was acquired from around 20 individuals. The tissue samples were formalin fixed and paraffin embedded (FFPE). Tissue microarrays (TMAs) cores from regions of interest were collected from the FFPE tissue samples, inserted in a recipient paraffin block and stored at room temperature. TMAs were dewaxed and spectra was collected for area of interest using DESI MSI. Following DESI-MSI, the TMAs slides were haematoxylin and eosin (H&E) stained for histopathological validation. Data analysis was performed using a new in-house toolbox where areas of interest were annotated. Additionally multivariate and univariate analysis were performed.
Results: DESI-MSI analysis was performed on FFPE TMAs from approximately 30 breast cancer samples and around 20 normal breast tissue samples. Most metabolites detected were small metabolites in the range 50-500 m/z for both positive and negative mode.
Conclusions: Our results indicate that DESI-MSI shows a potential to differentiate between different FFPE breast tissue types based on their metabolic profile. Additionally, our results show that inspite of formalin-fixation and paraffin embedding of the tissue we still have enough information to characterize the tissue.


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DirectMS1: A High-Throughput Analysis for Identification and Quantification of 1000 Proteins in 5 Minutes

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 8:50

Introduction:
Bottom-up proteome-wide analysis is based on the separation of proteolytic peptides followed by tandem mass-spectrometry (MS/MS). The latter step includes sequential isolation of the eluting peptides followed by their fragmentation. The needed fragmentation step is the bottleneck of the bottom-up proteomics limiting its use in biomedical applications. The MS/MS-based proteome analysis is slow and require long LC gradients for successful identification of low abundant proteins and providing high sequence coverage for quantification.

Objectives:
The primary objective of this study was to show limits and capabilities of mass-spectrometry based proteomics without using tandem mass spectra.

Methods:
Experiments were performed using high resolution mass-spectrometry Orbitrap (QExactive HF) coupled with Dionex nano-flow HPLC system. 5 minute LC gradients were used for this study. Different amounts of standard HeLa digest starting from as low as 1 ng were loaded for the shotgun analyses and efficiency comparison of proposed MS1-only and MS/MS-based methods. Quantification efficiency was tested on samples prepared in iPRG2015-like manner, where 6 proteins were spiked in yeast background in different concentrations. Data processing for protein identification and quantification which implements proposed MS1-only approach was performed using in-house developed software ms1searchpy and Diffacto software for quantification.

Results:
We report on LC-MS1 based approach outperforming regular data-dependent acquisition in terms of number of identified proteins, limit of detection and quantification accuracy when short LC gradients are used. In this study, up to 1000 protein groups were successfully identified in MS1-only mode for a standard HeLa cell line digest using a 5 minute LC gradient. The amount of loaded sample was varied in a range from 1 ng to 200 ng, and the method demonstrated 10-fold better sensitivity compared with the standard MS/MS-based approach. Comparison of the quantitation accuracy of the methods demonstrated significant outperformance of MS1-only approach over most common MS/MS LFQ methods (NSAF, MaxLFQ, Diffacto).

Conclusion:
Rapid MS1-only proteome characterization can be an alternative to the MS/MS-based “shotgun” analyses in the studies, in which the experimental time is more important than the depth of the proteome coverage.


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LC-MS/MS for Peptide-Adduct Analysis to Verify Poisoning with Chemical Warfare Agents and Pesticides

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 14:50

Introduction:
Chemical warfare agents (CWA) have been used in recent years in a variety of military conflicts as well as in terroristic attacks at the airport in Kuala Lumpur, Malaysia and in Salisbury, UK. Current relevance is attributed to nerve agents like sarin or the skin-active vesicants like sulfur mustard (SM). Since the use of CWAs is banned by the chemical weapons convention (CWC) it is strictly required for criminal prosecution to verify poisoning by CWAs through unambigous biomarker detection and verification.

Objectives:
This study describes the development and the application of a set of analytical methods to detect CWA-peptide-adducts as biomarkers of CWA poisoning by LC-MS/MS. Such adducts are formed as covalent reaction products of the CWA with endogeneous proteins like human serum albumin (HSA) or butyrylcholinesterase (BChE).

Methods:
Specific peptide-adduct biomarkers were developed from their corresponding proteins by plasma proteolysis using various proteases. Subsequently, separation and detection were carried out by selective micro-liquid chromatography ionization high-resolution tandem-mass spectrometry (LC-ESI MS/HR MS).

Results:
SM and nerve-agent-mediated poisoning in human samples was determined by detection of diverse albumin-derived and butyrylcholinesterase-derived protein adducts.
In case of SM, the SM-specific hydroxyethylthioethyl moiety bound to the thiol group of HSA Cys34 (C34*) or to the side-chain carboxylic group of HSA Glu230 (E230*) was used for detection. The corresponding peptide biomarkers were generated by proteinase K (C34*PF), pronase (C34*P), and pepsin (AE230*VSKL and LQQC34*PFEDHVKL) cleavage.
The presence of organophosphorus nerve agents and pesticides was also proven by the detection of their adducts with HAS as well as with BChE.

Discussion:
The methods developed provided unambiguous forensic evidence of CWA- and pesticide-exposure in real cases of human poisoning. Due to their long half-live of some weeks up to some months targeted protein-adducts are highly important post-exposure biomarkers beneficial for verification purposes.


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High-Throughput Automated Tissue Imaging by DESI-MS, Three-Dimensional Tissue Imaging or Large Sample Cohort Mapping

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 13:35



Introduction
One barrier to the adoption of imaging MS as a tissue imaging tool for clinical applications has been the time that is required per sample, which includes the sample preparation, set up of the experiment and then the acquisition time. With ambient techniques such as desorption electrospray ionisation there is no sample preparation step, and with the time per sample now in the range of minutes, not hours, then it is a highly suitable system to investigate automation.
Objectives
To demonstrate that it is possible to obtain reproducible and clinically significant data from large batches of tissue samples in an automated manner by DESI-MS imaging.
Methods
A DESI (Prosolia, Indianaopolis, US) stage was modified such that it could be coupled to a 200-capacity slide loader (Prior Scientific, Cambridge, UK). In house software was written to communicate between the mass spectrometer acquisition software and the control software of the slide loader. The result is a system where a number of slides can be placed into the cassettes and added into a queue. Each slide is sequentially loaded onto the stage where object detection algorithms locate the tissue section(s) and direct the analysis to that area. Realtime data processing software can monitor these analyses and give immediate results to the user if required.
Results
One method to demonstrate the applicability of this approach is to take many sections from the same tissue at different depths. These were then automatically imaged using the system described here and the data reconstructed to form three dimensional chemical maps of the tissues. Cancer related samples such as spheroids and mouse xenograft tumour have been mapped by this approach with regions of hypoxia and proliferation distinguished.
With the utility of the approach demonstrated, it was then used as a platform for quickly mapping a full tissue classification study. The benefit of being able to automatically conduct such a study in one batch is that the experimental variability is minimised, allowing the biologically significant differences both intra-sample but more importantly inter-sample to be more easily determined. After the batch analysis was completed, the slides were stained and annotated by a pathologist. The tissue specific regions of interest were extracted from each MS dataset and analysed by a host of multivariate techniques.
Conclusion
With improved performance and robustness, the implementation of an automated DESI-MS approach had become feasible. Demonstrations of the technology include multiple section imaging from the same tissue, for 3D mapping, and multiple sections from various tissues for building up tissue-specific mass spectrometry databases.


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Discovery of Species-Unique Peptides as Candidate Peptide Biomarkers for Respiratory Tract Pathogens Using Tandem Mass Spectrometry-based Proteotyping

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 10:30

INTRODUCTION. Respiratory tract infections are a major cause of clinical treatment, but clinical assessments and standard clinical laboratory protocols are time consuming and often insufficient for reliable diagnoses. New methods, preferably applied directly to clinical samples, without any culturing, are needed to improve diagnostics, provide adequate treatment and reduce the use of antibiotics and associated development of antibiotic resistance.
OBJECTIVES. To use tandem mass spectrometry-based proteotyping for discovery of species-unique peptides as potential biomarkers for bacterial pathogens commonly found in respiratory tract infections: Staphylococcus aureus; Moraxella catarrhalis; Haemophilus influenzae and Streptococcus pneumoniae.
METHODS. The workflow combined high-resolution accurate-mass (HRAM) tandem MS and the TCUP bioinformatics pipeline in the search for new species-unique peptides as potential biomarkers for respiratory pathogens. Species-unique peptides were discovered by analyzing both pure culture bacterial reference strains, which reflect the genomic variation in the four species and also clinical respiratory samples, without prior culturing, thus highlighting proteins expressed in clinical infection conditions.
RESULTS. For each of the four respiratory tract infectious pathogens, 15-20 peptide biomarker candidates most prominently found in direct analyses of clinical samples, were identified. To demonstrate the potential of using these species-unique peptides as effective peptide biomarker candidates for diagnosis of infectious diseases, targeted tandem MS analyses of clinical samples was performed and the relevance of the peptide biomarkers for identifying the pathogens, i.e., proteotyping, was shown.


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Imaging the Unimaginable with Imaging Mass Cytometry

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 15:45

The fetus is thought to be protected from exposure to foreign antigens, yet CD45RO+ T cells reside in the fetal intestine. Here we combined functional assays with mass cytometry, single-cell RNA sequencing and high-throughput T cell antigen receptor (TCR) sequencing to characterize the CD4+ T cell compartment in the human fetal intestine. We identified 22 CD4+ T cell clusters, including naive-like, regulatory-like and memory-like subpopulations, which were confirmed and further characterized at the transcriptional level. Memory-like CD4+ T cells had high expression of Ki-67, indicative of cell division, and CD5, a surrogate marker of TCR avidity, and produced the cytokines IFN-? and IL-2. Pathway analysis revealed a differentiation trajectory associated with cellular activation and proinflammatory effector functions, and TCR repertoire analysis indicated clonal expansions, distinct repertoire characteristics and interconnections between subpopulations of memory-like CD4+ T cells. Imaging mass cytometry indicated that memory-like CD4+ T cells colocalized with antigen-presenting cells. Collectively, these results provide evidence for the generation of memory-like CD4+ T cells in the human fetal intestine that is consistent with exposure to foreign antigens.


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MBT FAST – Rapid Antimicrobial Susceptibility Testing by MALDI-TOF MS

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 14:30

Introduction: Over the recent years, (multi-) drug resistant clinical isolates escalated resulting in a global threat that requires the fast and reliable detection of the corresponding resistance pattern. This is a major pre-requisite for an adequate and dedicated patient management and the prevention for further spread of those strains. We have developed a novel approach allowing MALDI-TOF mass spectrometry -based antibiotic susceptibility testing (AST), MBT FAST, within only a few hours.

METHODS: Twelve Enterobacteriaceae isolates comprising Escherichia coli, Klebsiella pneumoniae, Enterobacter spp. and Citrobacter spp. (each n = 3) and three Hafniaceae (Hafnia alvei) consecutive clinical isolates were investigated. A therapeutically relevant panel of seven antibiotics with anti-Enterobacterales activity including piperacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, ciprofloxacin, gentamicin and meropenem was tested at EUCAST breakpoint concentrations to allow categorisation as either susceptible or resistant. 6 µl of bacterial suspensions (5x105 cfu/ml) with and without antibiotics in cation-adjusted Mueller-Hinton broth were placed onto a Biotarget 96 (Bruker Daltonik), each sample in duplicate. The inoculated targets were incubated in a humidity chamber at 36°C for 4.5 hours. Subsequently, medium was removed using absorptive pads (Bruker Daltonik) and matrix was spotted onto the dried spots. Measurements were performed in duplicate, acquired spectra were analysed by a newly developed prototype software (Bruker Daltonik). Each isolate was tested independently three times and median results were calculated. Broth microdilution was used as reference method.

RESULTS: Comparison of the results obtained by the MBT FAST assay with those obtained by standard broth microdilution approach revealed a categorical agreement of 93.0% for all seven antibiotics. In contrast to 20 h incubation time necessary to perform the microdilution, the MALDI-TOF MS based assay was ready for readout already after 4.5 h incubation. Overall, 2.0% of the tested isolates showed false-resistant results and 5.0% showed false-susceptible results. The validity of the approach, i.e. successful detection of growth control, was 96%.

CONCLUSION: This study indicated that simultaneous susceptibility testing of antibiotics by MALDI-TOF MS-based MBT FAST is feasible and accurate within 4.5 hours. The whole workflow consists of pipetting steps and a simple liquid removal and can be performed without any centrifugation, therefore an automation of the procedure will be possible. The read-out can of results can be performed with standard routine MALDI-TOF mass spectrometers as they are available in most clinical microbiology laboratories today. Therefore, this method will be an attractive for rapid routine AST alternative for the future.


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The Human Glycome Project - Exploring the New Frontier in Personalised Medicine

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 10:30

The majority of proteins that evolved after appearance of multicellular life are glycosylated and glycans significantly affect structure and function of these proteins. However, due to structural complexity of glycans and the absence of a direct genetic template, the analysis of protein glycosylation is much more complicated than the analysis of DNA or proteins. Consequently, the knowledge about the importance of individual variation in glycans for both normal physiological processes and diseases is still limited. In the last few years it is becoming increasingly clear that variations in a DNA sequence are only a beginning of the understanding of complex human diseases. Genetic polymorphisms have to be put in the context of complex biology of life and a more elaborate approach that combines different ‘omics phenotypes is needed to understand disease mechanisms and perform patient stratification that transcends genomics. Glycomics, as by far the most complex posttranslational modification, has an immense potential in this respect, which is only beginning to be investigated. By generating glycomic data for over 80,000 individuals from some of the best characterised clinical and epidemiological cohorts we enabled glycomics to meet other ‘omics. The analysis of this rich gold mind is painting a picture of a very complex genetic and epigenetic regulation of glycosylation that fine tunes protein activity in multiple biological systems and, if altered, contributes to development of different complex diseases.


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Development of a Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry (LC-QTof MS) Method for the Screening of Antihypertensive Drugs in Urine

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 9:40

Background: Arterial hypertension is one of the most preventable causes of premature morbidity and mortality with resistant hypertension reported to be present in 5 to 30% of the total hypertensive population. Despite the poor prognosis, as many as 53% of those with resistant hypertension are reported to be non-adherent to their prescribed medication. This has led ourselves and others to develop LC-MS/MS methods to screen for the presence of antihypertensive drugs in urine. Despite the success of these assays, many suffer from not offering sufficient analytical breadth to cover all drugs prescribed in hypertension and/or not being able to identify key metabolites for some classes of drugs. Therefore we have developed a novel method for the detection of 49 commonly prescribed antihypertensive, antidiabetic and cardiovascular disease reducing medications in urine using LC-QTof MS.
Methods: Urine samples from 50 patients attending the hypertension clinic were analysed using an existing LC-MS/MS method and the LC-QTof MS method. For the LC-QTof MS method, urine samples were prepared using solid phase extraction and analysed using a Waters Xevo G2-XS LC-QTof MS system. Results obtained, and limit of detection for a number of drugs, were compared between the two methods.
Results: Limit of detection was comparable between the two methods with the majority of drugs detectable at 1 ng/mL. The newer LC-QTof MS detected all drugs found using LC-MS/MS in addition to drugs not screened for by the existing methodology. Felodipine, lercanidipine and lacidipine could not be identified in the urine of patients who were prescribed these drugs. However, using MSE we were able to identify metabolites of these drugs (termed felodipine M3, lercanidipine PA3 and lacidipine M3) in these patients.
Conclusions: The LC-QTof MS method presented here shows similar sensitivity to existing LC-MS/MS assays but is able to screen for more drugs and metabolites and, due to the nature of data acquisition, is flexible should more drugs need to be added to the screen. The results presented here also show that interrogation of MSE datasets is a suitable technique to identify metabolites of drugs of interest should parent compounds not be present in target biological matrices.


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Investigation of Bacterial β-Glucuronidase Inhibition on the Metabolic Profile of Mice Using a Combined Platform of NMR and LCMS-based Untargeted Metabolomics

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 9:20

Irinotecan is a drug used as a chemotherapy agent mainly to treat colorectal cancer. Despite its remarkable efficacy, the gastrointestinal toxicity induced by the drug is life-threatening and often lead to an interruption of the treatment. Indeed, irinotecan is a pro-drug from which the active form is SN-38. Once reaching the liver, SN-38 is conjugated with glucuronic acid to then be excreted. However, once SN-38-G reaches the gut, a bacterial enzyme β-glucuronidase cleaves the glucuronic acid, releasing the aglycone SN-38 back into the GI tract, which is inducing the gastrointestinal toxicity. Even if inhibition of β-glucuronidase had proved to remove the ADRs from SN-38 in mice, it is logical to think that if this bacterial enzyme, which is present in more than 43% of the Human Microbiome Project Database species, might be affecting other metabolic pathways. In a project aiming to explore the potential to target the microbiome by selectively inhibit the bacterial β-glucuronidase, a 1H NMR spectroscopy and UPLC-MS metabolomics platform was used in order to assess the effect of this inhibitor on the metabolic profile of mice, particularly on the liver, gall bladder, colon tissues, plasma, urine, faeces and colon contents. A metabolic shift was observed only for the colon contents, faeces and urine samples, as well as a very slight one for the colon tissues. The metabolites significantly affected by the treatment seem to be mainly microbial metabolites, although metabolite identification process is still on-going. In another study where mice were treated with both the inhibitor and SN-38, the targeted UPLC-MS analysis of intestinal contents and plasma revealed the presence of different SN-38-G forms, potentially explained by a ring-opening mechanism leading to the carboxylate form of the molecule. Structural elucidation of these SN-38-G forms will be performed with high-resolution ion mobility mass spectrometry. Overall, even if further studies are needed to confirm preliminary findings, the inhibition of bacterial β-glucuronidase seems promising.


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MALDI-TOF/MS Analyses of Urinary Phospholipids and Lysophospholipids as Potential Diagnostic Biomarkers for Prostate Cancer

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 14:30

BACKGROUND & OBJECTIVES
The altered phospholipids in prostate tissues have been reported as potential biomarkers for prostate cancer (PCa) diagnosis or prediction of the biochemical recurrence after surgical treatment in our previous studies. Urinary lipidomics has great potential in clinical diagnostics and prognostics, especially for PCa. Matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOF/MS) is increasingly used in the lipid research which enables a rapid screening of phospholipids. Therefore, a urinary phospholipid screening was performed utilizing MALDI-TOF/MS analyses in order to search for new biomarker candidates in a non-invasive way.

MATERIALS & METHODS
The lipids were extracted by the acidified Bligh-Dyer method from the digital rectal examination (DRE) urine which contains many kinds of lipids secreted from prostatic microenvironment thus enable the detection of prostate-specific products as sources for potential PCa biomarkers. The urinary lipidomic screening was performed by MALDI-TOF/MS (AXIMA Performance, Shimadzu Kratos Analytical, Manchester, UK) in the urine samples collected from 30 PCa and 30 benign prostatic hyperplasia (BPH) patients after DRE. Lipids were identified by MALDI-TOF/MS2 analyses. The compositions of lysophosphatidylcholine (LPC) and phosphatidylcholine (PC) were compared between the PCa and BPH groups.

RESULTS
The urinary phospholipids including LPC, PC, and sphingomyelin (SM) species were detected by MALDI-TOF/MS and identified by MALDI-TOF/MS2 in a reflectron positive mode. Among them, LPC and PC species were relatively abundant and with good reproducibility in the DRE urine samples. The peaks of synthetic LPC and PC molecules spiked in the urine were detected by MALDI-TOF/MS and a linear correlation was confirmed between their concentrations and peak intensity ratios. The compositions of LPC and PC in the urine samples were statistically significant differences between the PCa and BPH groups.

CONCLUSION
Our comparative screening of phospholipid biomarkers enables the DRE urine samples to be applied for PCa diagnosis. The detection of PC and LPC species in the DRE urine samples is feasible and with good reproducibility. The altered PC and LPC compositions in the DRE urine determined by MALDI-TOF/MS may be used as a simple and non-invasive biomarker for the PCa.


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Antibody Sequencing and Quantitation

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 13:15

The metabotropic glutamate receptor-1 (mGluR1) has recently been identified as an oncogene that is abundantly expressed in >60% of human melanoma, breast, renal cell and prostate cancer tissues. Many of these cancers cannot be successfully treated and new treatment modalities are clearly needed. In 2003, glutamate signalling through mGluR1 was reported to be a promising new molecular target for the treatment of cancer. We identified that affinity purified mGluR1 autoantibodies from plasma from a unique ataxia patient effectively block the mGluR1 receptor both in vitro and in vivo. These fully matured human antibodies are selective and have high target affinity. The precise sequence of these antibodies would offer an attractive basis for the development of a new antibody-based therapy for mGluR1 dependent cancers.

We have developed a novel technology pipeline for mass spectrometry (MS) based protein sequencing of full length human antibodies from plasma and reveal the full length sequence of the anti-mGLuR1 antibodies. The recovery of fully matured human derived autoantibody sequences with this pipeline has great potential for therapeutics. Existing antibody-based therapies rely on antibodies raised in other species, which can evoke anti-drug responses and are less efficient than human autoantibodies. In order to successfully develop the MS based protein sequencing pipeline, we have optimized antibody enrichment from plasma samples, advance novel protocols for MS sample preparation, and develop state-of-the-art MS analysis tools to derive protein sequences from the complex data output. In this way, we will produce an anti-mGluR1 antibody with therapeutic potential, and a pipeline that allows for the recovery of additional fully matured human derived antibody sequences for other indications like multiple myeloma.



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Colorectal Cancer Cell Lines Reveal Striking Isomeric Diversity of Human Cancer O-Glycome

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 9:10

INTRODUCTION: Over the past few years many studies have demonstrated the importance of altered glycosylation in tumor progression. These findings may contribute to discovery of biomarkers and treatment targets as well as understanding cancer biology. N-glycosylation of colorectal cancer (CRC) cell lines has been recently characterized revealing the association of antennary fucosylation with cell line differentiation and Caudal Type Homebox 1 (CDX1) expression. However, little is known about O-glycosylation of CRC cell lines due to its complexity, the presence of multiple isomeric structures as well as lack of enzymatic release methods making it overall challenging to perform in-depth analysis. OBJECTIVES: To provide a better understanding of the variation in O-glycosylation phenotypes and their association with other molecular features, an in-depth O-glycosylation analysis of 26 different colorectal cancer cell lines was performed.
METHODS: We have further optimized a high-throughput sample preparation procedure that now allows the release of O-glycans from only 0.5 million cells in a 96-well plate format. Proteins were immobilized on a PVDF membrane that allowed the release of N-glycans with PNGase F digestion prior to the O-glycan release via reductive β elimination. The samples, containing released O-glycans, were analysed on a sensitive nano-porous graphitized carbon liquid chromatography system coupled to an ion trap mass spectrometer via electrospray ionization (nano-PGC-LC-ESI-MS) allowing isomeric separation of the O-glycan species. Isomeric structures could be identified via their cross-ring and glycosidic fragment ions generated in negative ionization mode.
RESULTS: Striking differences were observed between the O-glycome of 26 colorectal cancer cell lines. We have detected many yet undescribed O-GalNAc linked glycans with a total of nearly 180 different structures. The profiles of all cell lines were dominated by sialylated glycan species formed by elongation of mainly core 2 and core 1 structures. Unsupervised principal component analysis based on structural glycan features revealed a separation between well differentiated colon-like and undifferentiated cell lines. Colon-like cell lines were mainly characterized by a prevalence of I-branched and sialyl Lewis X/A epitope carrying glycans, which showed correlation with the expression of relevant glycosyltransferases. In contrast, the majority of the undifferentiated cell lines showed absence of Lewis type epitope expression together with increased blood group antigen H, A and B expression.
CONCLUSION: Major differences were revealed between the O-glycosylation profiles of a panel of 26 colorectal cancer cell lines. The large biological variation observed within this study indicates that when studying glycobiological changes in cancer, cell line variation must be considered.


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Large-Scale Inference of Protein Tissue Origin in Sepsis Plasma Using Quantitative Targeted Proteomics

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 11:00

The blood plasma proteome is maintained by influx and efflux of proteins from surrounding cells and organs. The liver secretes the majority of the highly abundant plasma proteins, the so-called classical plasma proteins, involved in the principal functions of plasma such as serving as transport medium, provide colloid osmotic pressure and maintaining hemostasis through the complement and coagulation systems. Blood plasma also contains numerous tissue proteins that most likely do not contribute to the principal functions of blood plasma. This group of proteins is more numerous than the classical plasma proteins and their role, if any, in the plasma is unclear. A subset of these proteins may be waste products resulting from the turnover of proteins and cells under physiological and pathological conditions.
To investigate the complex processes that control the composition of the plasma proteome, we have developed a mass spectrometry-based proteomics strategy to infer the most likely tissue origin of the proteins detected in blood plasma. The strategy relies on the construction of a large-scale protein tissue distribution atlas from cells and highly vascularized organs using shotgun mass spectrometry. The protein tissue atlas was subsequently transformed to a spectral library to enable sensitive and reproducible quantification of tissue-enriched proteins directly in plasma using SWATH-like data-independent mass spectrometry analysis. Here, we show that analysis of septic blood plasma reveals a drastic reorganization of the blood plasma proteome related to disease severity, where part of the plasma proteome followed a disease-dependent reorganization. On the contrary, certain tissue-enriched proteins were increased predominately in the most severely ill subjects. The increase of tissue proteins in critically ill subjects may indicate early signs of organ failure, a hallmark of sepsis pathology.


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Can Rapid Evaporative Ionization Mass Spectrometry (REIMS), the Intelligent Surgical Knife (iKnife) Provide a Point-of-Care Diagnosis for Endometrial Cancer

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 14:50

Introduction:

Endometrial cancer is the most common gynaecological cancer in the western world with over 7000 and 88’000 new cases diagnosed per year, in the UK and European Union respectively.

Following pelvic ultrasound imaging the diagnosis of endometrial cancer is confirmed by histological examination of endometrial curetting’s or more commonly outpatient endometrial biopsy e.g. pipelle. Histological examination of the tissue often takes up to two weeks. This wait adds significant anxiety and distress for patients awaiting results. To-date there is no POC diagnosis available. The intelligent surgical knife (‘iKnife’) analyses tissue real-time but has never been used to diagnose endometrial cancer, thus far.

The purpose of this research is to establish whether the iKnife can distinguish between normal and malignant endometrial tissues based on differences in tissue-specific lipidomic profiles.

Methods:

Research pipelle biopsy samples were obtained for women needing biopsies for clinical reasons (samples concurrently sent to conventional histopathology).

A Waters G2-XS Xevo Q-TOF mass spectrometer was used in conjunction with a modified handheld diathermy. The latter converts tissue constituents to gas phase ionic species that are then drawn into the MS-inlet through the REIMS interface. A solution of Isopropyl Alcohol and leucine encephalin was sprayed towards to the REIMS interface.

The resultant surgical aerosol containing ionic species produced during diathermy was then analysed with this technology; producing spectra that are background subtracted, lock mass corrected and in the phospholipid range. Principal component analysis (PCA) and linear discriminant analysis (LDA) were then performed to find the variance in spectral signatures between benign and malignant endometrial tissues. A leave one patient out cross validation was used to obtain diagnostic accuracy.

Results:

134 pipelle biopsy samples (73 normal and 61 malignant) were obtained. Each tissue sample was processed using the technique above using the cutting setting; producing an individual spectrum per burn.

A loading plot was created for the first principle component, in addition to ANOVA. It revealed several key m/z values were associated with the separation between normal and malignant tissue.

PCA score plots were created. The supervised LDA plot separated the results into tissue specific clouds of data. A leave one patient out cross validation was performed. In this validation method the diagnostic accuracy was 80%.

Summary:

This pilot study is the first to use the iKnife as a tool to distinguish between normal and malignant endometrial pipelle samples. These results are promising and suggest that the iKnife could be used as an aide in clinic to provide a POC diagnosis.


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Metabolomics Applied to Coronary Clinical Burden: Use of Mass Spectrometry to Re-Stratify Asymptomatic Subjects of Intermediate Cardiovascular Risk

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 11:20

Introduction
Early detection of subclinical atherosclerosis has a major impact on the prevention actions of manifest coronary disease. The management of asymptomatic patients with intermediate Framingham risk is considered uncertain and additional tests are recommended to personalize the risk estimates. Prospection of metabolic markers and the evaluation of the detailed characteristics of the plaque with atherosclerotic burden score can be used as a complementary technique for re-stratification of the risk. Purpose: Compare the overall metabolic profile among patients with coronary plaques classified by modified Leaman score (CT-LeSc) versus control subjects (without plaques), using mass spectrometry (MS), correlating patient’s clinical data with possible molecular discriminants, for re-stratification of cardiovascular risk.

Methods
20 asymptomatic subjects classified as intermediate coronary artery disease risk according to the Framingham risk score, and with myocardial perfusion scintigraphy negative for ischemia and normal left ventricular fraction on transthoracic echocardiography, were recruited into four groups according to coronary computed tomography angiography (CCTA) and CT – LeSc: T1 (0,3 - 3,7); T2 (3,8 - 8,2); T3 (8,3 – 24,1) terciles. Plasma non-targeted metabolomics approach with UPLC-QTOF/MS was applied. Raw data was pre-processed in XCMS to extract chemical entities. Non-parametric univariate analysis and non-supervised (PCA), as well as supervised (PLS-DA) multivariate analysis were used to obtain the significant molecular features (p<0.05, VIP>1). CEU Mass Mediator was used to putatively identify the significant metabolites. The metabolic profile was compared with calcium score, carotid intima-media thickness, high sensitivity C-reactive protein and a family history of atherosclerotic disease regarding the capacity to reclassify cardiovascular risk.

Results
More than 2000 molecular features were extracted from the raw data. PLS-DA of the lipid profiles based on CT-LeSc showed good classification power (Q2=0.8960). No lipid profile showed discriminatory power when patients were classified based under calcified plaques (CP) and non-calcified and mixed plaques (NCMP), which is the current method on clinics to plaque characterization. 53 molecular features (MF) had significance both in uni- and multivariate analysis. 17 MF could be annotated. Phosphatidylethanolamine, phosphatidylcoline and cardiolipins were more abundant in the highest Leaman score groups (T2/T3).

Conclusions & Discussion
The global lipid profile of asymptomatic subjects at Framingham intermediate risk of coronary artery disease may be useful as a complementary molecular marker presenting valuable discriminant power between the different tomographic Leaman phenotypes. Unlike the classification based only on the presence of plaque calcification, the Leaman score discriminated with greater accuracy. The implementation of this high-performance analysis by MS forecasts an important future impact in the prevention of clinical events focusing on patients whose traditional risk markers fail to correctly stratify subjects. Application of new biomarkers with clinical utility may transform cardiovascular care, improving new diagnostic approach to subclinical atherosclerosis and enabling a more personalized medicine.

We acknowledge Dr. Francisco Laurindo for valuable discussion on cardiolipins role in atherosclerosis. To Carolina Gonzáles-Riaño and Dra. Joanna Godzien from CEMBIO for valuable tips on metabolites identification. To LBBQ/UnB, especially to Dr. Wagner Fontes.


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A Novel LC-MS/MS Method for the Quantification of Five Androgens in Saliva

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 13:35

Background
Androgenic activity is mediated by a combination of classical and 11-oxygenated androgens. Saliva production is generally more convenient than blood collection for patients since it is less invasive and does not require the patient to visit hospital or primary care for phlebotomy. We have developed an LC-MS/MS assay for the simultaneous measurement of testosterone, androstenedione, 17-hydroxyprogesterone, 11-ketotestosterone and 11-hydroxyandrostenedione in saliva.

Methods
Samples (250 µL of unstimulated whole saliva) were prepared by supported liquid extraction with methyl tert-butyl ether (MTBE) and reconstituted in 40% methanol. Liquid chromatography was on a Waters T3 column using a water (0.1% formic acid and 2 mmol/L ammonium acetate) / acetonitrile gradient. A TQ-XS Waters mass spectrometer was used for quantification.

Results
Total run time was four minutes per sample. A full validation of the method was performed including precision analysis, assessment of the lower limit of quantitation, as well as linearity, matrix effect, recovery, carryover and interference studies. Additionally, results from this method were compared to a previously published LC-MS/MS method for the five salivary androgens using saliva samples from healthy volunteers.

Conclusion
We present a novel LC-MS/MS method for the quantification of five androgens in saliva.


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Ultrahigh Resolution MS Profiling of Plasma N-Glycans in Large Type 2 Diabetes Cohorts

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 11:20

Introduction
Type 2 diabetes mellitus(T2D)represents a major public health challenge. The total plasma N-glycome(TPNG)reflects the levels and glycosylation of major plasma glycoproteins, among which are immunoglobulins, acute-phase proteins and apolipoproteins. Our group and others recently reported on associations between TPNG and T2D, using MALDI-TOF-MS or UPLC. However, little is known on possible links between TPNG and vascular complications of T2D which are the major cause for T2D morbidity and mortality. Here, we applied our new ultrahigh-resolution MS method to assess associations of TPNG with T2D and T2D complications.
Methods
We determined the TPNG in a subsample of the Hoorn Diabetes Care System(DCS) cohort(n = 1519 T2D cases and 192 nondiabetic controls from the new Hoorn study) using our ultrahigh-resolution Fourier-transform ion cyclotron resonance mass spectrometry(MALDI-FTICR-MS) method. Blood plasma samples were randomized over 21 96-well plates, together with technical replicates. Prior to MS analysis, N-glycans were released using PNGase F. For stabilization and linkage differentiation, sialic acids were derivatized. Released glycans were purified and spotted using an automated liquid handling platform. In total, 68 individual glycan compositions were quantified after total-area normalization and summarized into derived traits representing structural features. By applying logistic regression models, we tested for associations of glycan features with case-control status and micro- or macrovascular complications, with adjustment for age, sex, and T2D risk factors.
Results
The recently developed method using MALDI-FTICR-MS improved resolution, mass accuracy, dynamic range and the signal-to-noise ratio, especially for larger glycans, in comparison to our previous MALDI-TOF workflow. The relative standard deviation over the 68 detected glycan species was on average 6.6 %, based on the relative intensities from 93 technical replicates of pooled plasma, representing total method repeatability.
Applying the new method on the DCS cohort, we were able to replicate previously reported associations of TPNG with T2D, such a decreased alpha2,3-sialylation of triantennary glycans(odds ratio(OR) = 0.47 and p = 1.12E-17) or increased alpha2,3-sialylation of various di- and tetraantennary structures(e.g. per-galactose 2,6-sialylation in diantennaries: OR = 2.36 and p = 2.54E-26), after adjustment for age and sex. Moreover, we found additional associations, e.g. for antennary fucosylation of triantennaries(OR = 1.62, p= 2.85E-07), likely a consequence of improved method sensitivity. Statistical analyses of associations between TPNG and T2D complications are ongoing.
Conclusions
Our new method improved the detection of several glycan species, thus providing possible new insights into the association between TPNG and T2D. Our results will be taken forward to improve personalized approaches in T2D and related complications in the future.


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Imaging Spatial Abeta Plaque Aggregation Dynamics in Evolving AD Pathology Using iSILK

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 13:15

Introduction:
Delineating the fate of various amyloid fibrillary structures in evolving Aβ pathology, is of key importance for our understanding of nerve cell death, clinical symptoms, and neurodegenerative progression in Alzheimer’s disease (AD) pathology. This is partly because in humans we can only look in detail after death and in mice we can only see a particular point in time without any longitudinal information on the fate of individually formed deposits.
We here report a novel approach, iSILK, based on metabolic labelling of proteins with stable isotopes together with ultrahigh resolution imaging for studying amyloid plaque formation dynamics in novel knock-in mouse models of AD.

Methods
Imaging of stable isotope labelling kinetics (iSILK) was performed in recently developed APP NL-G-F knock-in mouse model of AD. This to monitor the earliest seeds of Aβ deposition through ongoing plaque development and track the deposition of Aβ that is produced later in relation to already deposited plaques. For this we fed mice a diet containing a stable isotope (15N) just prior to plaque onset (PNW12) until plaque pathology was prominently manifested (PNW16). We analyzed the stable isotope enrichment in brain tissue and plaques in these mice using multimodal chemical imaging, including scanning transmission electron microscopy (STEM) nanoscale secondary ion mass spectrometry (nanoSIMS), matrix assisted laser desorption mass spectrometry (MALDI-IMS) and fluorescent structural amyloid staining (Hyperspectral LSM).

Results
The data reveal early formation of plaques consisting primarily of Aβ1-42 in cortical areas followed by later deposition within the hippocampus. NanoSIMS reveal that these plaques form first a core structure consisting of highly abundant, soluble Aβ1-42 secreted prior to plaque deposition. In addition, these plaques form radiating diffuse fibers that evolve at a later time from the core seed. Further, other C-terminal Aβ species, including Aβ1-38 were found to be secreted at a later time during evolving plaque pathology, and were processed prior to deposition to pre-exiting Aβ1-42 containing plaque structures.

Conclusions
These data bring considerable novel information about the deposition mechanism of Aβ. In detail, our data show that plaque pathology is seeded by Aβ1-42, forming distinct amyloid structures that evolve into plaques. Further these data show us that the cortex is the first site of plaque deposition, something that is well in line with other mouse models. Further, we show that C-terminal Aβ processing is occurring prior to deposition and not associated with plaque specific mechanisms.
Taken together these results provide significant novel insight for understanding the earliest stages of Alzheimer’s disease and the ongoing progressive changes in amyloidosis.


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The Development of Targeted Proteomic Assays, Attempting to Take Biomarkers from the Research Lab to the Clinic

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 14:30

The development of targeted proteomic assays, attempting to take biomarkers from the research lab to the clinic.

Almost all large hospitals have LC-triple quadrupole based mass spectrometry platforms. These robust and versatile instruments are used for a multitude of small molecule analyses including amino acids, glycosphingolipids, glucosaminoglycans, vitamins as well as for monitoring immunosuppressant levels, drug trials and neonatal screening for inborn errors of metabolism. However, rarely are these instruments used in a clinical setting for the analyses of proteins and are usually analysed using immunochemistry based assays (ELISA, radioimmunoassays etc).

LC-MS based analyses, particularly with stable isotope labelled internal standards, are unparalleled for their accuracy and assay reproducibility with intra- and inter-assay coefficients of variations of often less than 2% and 5-8%, respectively. This is substantially lower than that of many immunochemistry based protein assays which often have intra- and inter-assay based coefficients in the range of 10-25%. Therefore, it is logical to try to combine the accuracy and reproducibility of LC-MS based platforms to analyse proteins in a clinical setting. This type of analysis has other added advantages over immuno-based technology including;

• Cost implications (no need to purchase kit based systems from a third party)
• Multiplexing up to 50-80 proteins in a single analysis
• Validation of biomarkers from discovery experiments
• the ability to translate biomarkers into routine tests in a clinical setting much quicker than having to wait for the development to market of a kite marked kit.

The work of my research group attempts to bridge the gap between finding a biomarker in a research lab to its validation and potential translation of that test into a clinical setting. I will give several examples of this where we have found biomarkers in plasma, urine and CSF and translated them into multiplexed tests. The diseases I will cover will include inborn errors of metabolism (Fabry Disease), hypertrophic cardiomyopathy and the neurodegenerative conditions of Alzheimer’s and Parkinson’s disease.


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Maximize the Output of Routine Proteome Analyses by Using Micro Pillar Array Column Technology

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 08:30

INTRODUCTION
As an alternative to the conventional packed bed nano LC columns that are frequently used in bottom-up proteomics research, PharmaFluidics off¬ers micromachined nano LC chip columns known as micro pillar array columns (μPAC™). The inherent high permeability and low ‘on-column’ dispersion obtained by the perfect order of the separation bed makes μPAC™ based chromatography unique in its kind. The peak dispersion originating from heterogeneous flow paths in the separation bed is eliminated (no A-term contributions) and therefore components remain much more concentrated during separation resulting in unprecedented separation performance. The freestanding nature of the pillars also leads to much lower backpressure allowing an high operational flow rate flexibility with exceptional peak capacities.
RESULTS
Complementary to its landmark 200 cm long column which is ideally suited to perform comprehensive proteome research, a 50 cm long μPAC™ column is now available which can be used in a more routine research setting. With an internal volume of 3 μL, this column is perfectly suited to perform high throughput analyses with shorter gradient solvent times (30, 60 and 90 minute gradients) and it can be used over a wide range of flow rates, between 100 and 2000 nL/min. Recently performed experiments with 500 ng of HeLa cell digest indicate that an increase in protein identifications up to 50% and a gain of 70% in peptide identifications can be achieved when comparing the 50 cm µPAC™ column to the current state-of-the-art in packed bed columns. The conventional packed bed columns (2 different vendors) used for this benchmarking experiment were 15 cm in length and were packed with sub 2 µm porous silica particles. LC pump pressures needed to operate these classical columns at a flow rate of 300 nL/min range between 200 and 300 bar, whereas only 40 bar was need to operate the 50 cm µPAC™ column at the same conditions.
CONCLUSION
μPAC™ technology clearly offers several benefits regarding robustness, high operational flexibility and excellent separation performance compared to conventional packed bed column technology. When aiming for comprehensive proteome analysis with deep coverage, the 200 cm long μPAC™ column which delivers unprecedented separation performance is the best choice. However, the true benefits of using a long 200 cm μPAC™ column will only come into full play when working with long solvent gradient times (>120min). With an internal
column volume of approximately 3 μL and an increased operational flexibility (flow rates up to 2000 nL/min), the
50 cm μPAC™ column serves those who are looking for increased separation performance in daily routine proteome
analysis settings where shorter gradient times (<120min) and increased throughput are desired.


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Multi-Analyte Methods: A Free Lunch or a Frightening Bill?

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Thursday at 08:30

Building multi-analyte LC-MS assays is a common temptation in Laboratories who are often faced with the drive to do “more with less”. This is especially true when the analytes in question are related clinically and share similar phys/chem properties. Adding these extra analytes can seem like additional data for free. However, in addition to extra logistical requirements (Increased cals, QCs, QA samples, data review, troubleshooting) there are analytical challenges to overcome such as differing stabilities and recoveries, different relative sensitivities, and the purity of reference standards that raise the question – how free is it really?

This session will comprise of an introduction into multi-analyte methods and their limitations, followed by a case study of the development of a LC-MS assay for the measurement of five atypical anti-psychotics, with a final practical session where the audience will be split into groups to discuss theoretical examples.

Take home ‘pearls’
• Being able to identify the common pitfalls with multi-analyte methods and how to avoid falling into them
• Knowing the steps that can be taken to assess potential issues during method development
• An understanding of the limitations of large multi-analyte methods and the fundamental issues with demonstrating control over assays of this nature.


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Determination of Aldehydes, Ketones, Short Chain Fatty Acids and Alkanes in Breath and Biofluids with GcxGC-TOF-MS-FID

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 13:35

Introduction: Volatolomics is the study of the volatile organic compounds (VOC) and one of the most fast-growing fields in non-invasive diagnostics. Several prospective clinical series have shown exhaled aldehydes, ketones, alkanes and short chain fatty acids to accurately identify patients with cancer. GC-MS primarily and online-MS, as proton transfer reaction-MS or selected ion flow tube-MS, are the most widely used platforms for VOC profiling. They have showed high coverage of the volatolome, low detection limits and high-throughput. However, they lack selectivity in several categories of chemical compounds (e.g. structural isomers). In these cases, multidimensional GC combined with high resolution MS can offer the required resolving power for the robust separation and determination.
In this study, we aim to develop a quantitative method for the concurrent determination of alkanes, short chain fatty acids, ketones and aldehydes in human breath, biofluids and tissue. The key-steps for the optimisation of the method are I) the sample-preparation procedure, II) the derivatisation protocol and III) a chromatographic method which will enable the concurrent separation of the wide-polarity range compounds and V) the application to a human cohort.

Methods: All samples are spiked with isotopically labeled internal standards. Breath samples are collected in tenax/carbograph thermal desorption tubes. Human tissue and biofluids are homogenized with bead beading, acidified and cleaned-up with liquid-liquid extraction. Finally, ketones and aldehydes are derivatized to oxime analogues. The samples are analyzed in a Markes Bench-TOF Select GCxGC system, equipped with a SepSolve flow modulator, a liquid autosampler and a Markes TD-100-XR thermal desorber. The primary column is an Agilent DB-WAX UI (20m x 0.180mm, 0.18μm) and the secondary an SGE BPX5 (5m x 0.25mm, 0.1μm). Data are acquired and processed with ChromSpace (SepSolve).

Results and Discussion: Liquid/liquid extraction with acidification is highlighted as the most effective clean-up technique and demonstrated high recoveries for most of the target compounds. Oximation with O-(2,3,4,5,6-Pentafluorobenzyl)hydroxylamine hydrochloride (PFBHA·HCl) allows the baseline separation of ketones and aldehydes and greatly reduces their detection limits while the reaction takes place in room temperature. Short chain fatty acids are separated and detected without derivatization however their methylation is evaluated as an extra derivatization step to further increase their chromatographic performance and the detection of the higher molecular weight ones. Furthermore, blank contaminations, linearity range, recoveries, intra- and inter- day reproducibility are evaluated for each target analyte.


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Skin Lipidomics in the Diagnosis and Treatment of Cutaneous Inflammation

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 15:45

Skin depends on a unique profile of lipids that are necessary for the correct structure and function of the epidermal barrier, management of cellular communications and regulation of cutaneous homeostasis. Alterations in the cutaneous lipid profile can have severe consequences for skin health and such changes have been implicated in many inflammatory skin conditions. Using a targeted lipidomics platform we have investigated the prevalence of bioactive lipids in human skin, and reported an array of eicosanoids, octadecanoids, docosanoids, endocannabinoids, acyl ethanolamines and ceramides. We have conducted clinical studies and used human skin organ culture models and isolated cells in order to explore the differential contributions of lipid families to skin conditions. We have also explored lipid responses to various stimuli, and have examined temporal changes in lipid profiles aiming to understand their contribution to acute cutaneous inflammation and its resolution. Systemic supplementation with omega-3 polyunsaturated fatty acids (PUFA) has also revealed the differing cutaneous activities of these protective fatty acids, and demonstrated how they mediate their activities through perturbation of the profiles of existing species as well as formation of new lipids. Overall, we have shown that targeted lipidomics can elucidate the network of cutaneous bioactive lipids, support the development of biomarkers and diagnostics, and identify therapeutic targets for inflammatory skin disease.


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Potential of MALDI MS for Detection of [Ru(η5-C5H5)(PPh3)2Cl] Metabolites in Patient Body Fluids – a Preliminary Study

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 10:50

INTRODUCTION: Ruthenium metallocomplexes are promising candidates for anti-tumour therapy, which can be efficient even against tumours that are resistant to cisplatin. Cyclopentadienylbis(triphenylphosphine)ruthenium(II) chloride ([Ru(η5-C5H5)(PPh3)2Cl], RuCp in the text), as reported previously by us, presented in vitro significant cytotoxicity properties against several types of cancer cell lines.

OBJECTIVES: To study the possibility for detection of metabolized ruthenium-based metallodrug in patient´s urine and other body fluids by matrix-assisted laser desorption and ionization mass spectrometry (MALDI MS) without purification.

METHODS: RuCp was synthesized and characterized by common spectroscopic techniques. Mass spectra were acquired on the Bruker Autoflex Max MALDI TOF/TOF device in the positive and negative ion mode. Various concentrations of RuCp dissolved in 1.5 M NaCl were applied on the stainless steel MALDI target without matrix, or with either α-cyano-hydroxycinnamic acid (CHCA) or 2,5-dihydroxybenzoic acid (DHB), both at 10 mg/mL in 50 % acetonitrile and 0.05 % trifluoroacetic acid. In additional experiments, urine samples were analyzed when spiked with various concentrations of RuCp.

RESULTS: In the presence of 1.5 M NaCl, i.e. under physiological solutions, RuCp yields various signals in the MALDI TOF mass spectra, both in the positive and in the negative ion mode. Ions related to the Ru-complex were generated by the loss of ligands (or ligand fragments), followed by hydrolysis. Since photoactive, RuCp can be detected even without organic matrix (LDI mass spectra), but in this case, the extent of fragmentation was increased when compared to the spectra acquired with the matrix. In positive ion mode and in all spectra, the fragment at the position m/z 429.3 was detectable, which corresponds to the species generated by the loss of a triphenylphosphine group and a chloride ion. Additionally, in the presence of NaCl, these species were detected below 4.7 nM concentration.

CONCLUSION: We have shown that very low concentrations of RuCp potential metabolites can be detected in the presence of physiologically relevant concentrations of NaCl, without the necessity of further separation. Also, structural analysis of a metabolite is possible, which makes this approach potentially useful in clinics as the method for monitoring the effect of patient´s therapy with metallodrugs.

Acknowledgements: We acknowledge FCT for funding through the CQM PEst-OE/QUI/UI0674/2019, IDR and Madeira 14-20 Program through the project PROEQUIPRAM – Reforço do Investimento em Equipamentos e Infraestruturas Científicas na RAM – (M1420-01-0145-FEDER-000008) and ARDITI – Agência Regional para o Desenvolvimento da Investigação Tecnologia e Inovação – through the project M1420-01-0145-FEDER-000005 – CQM+ (Madeira 14-20 Program).


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Towards In vivo Molecular Diagnostics of Esogastric Cancer with Spidermass Real-Time, Mini Invasive Analysis

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 15:10

Introduction: Esogastric cancer is the fourth most commonly diagnosed cancer. Poorly cohesive carcinoma is sometimes difficult to identify via histopathology and presents a challenge for rapid and accurate diagnostics. The extent of the esogastric cancer cannot be deduced from the initial CT-scan or endoscopy exam, thus surgery needs to be performed followed by an intraoperative pathology exam. This exam is long and shows and error rate of about 30%. There is then an urgent need for a novel technology allowing for guided surgery and real-time diagnostic using specific molecular signatures in esogastric cancer while being of minimal invasiveness to the patient’s tissue. The water-assisted laser desorption/ionization mass spectrometry (SpiderMass) has demonstrated the capability to analyse biopsies ex vivo, allowing for correct classification of tumour type and grading (Saudemont et al. Cancer Cell 2018). Herein, we present a pipeline for ex vivo analysis using the SpiderMass system combined with Mass Spectrometry Imaging to asses and classify esogastric cancer.
Objectives: Our aim is to improve intraoperative diagnosis of esogastric cancer.
Methods: Fresh-frozen biopsies of gastric cancer and normal tissue were supplied by the FREGAT (www.fregat-database.org). The small biopsies were sectioned for histopathological examination (5µm), SpiderMass (20µm) and MALDI Imaging (12µm) in 3 rounds. The SpiderMass uses a mini invasive IR-laser microprobe tuned to excite the most intense vibrational band of water. The microprobe is connected to the Xevo instrument via a transfer tube. Three molecular profiles were created of selected regions using 10 s irradiation steps in positive and negative ion mode. The data collected was processed via supervised Abstract Model Builder (Waters) and unsupervised "home-built" software. For MALDI analysis the sections were coated with Norharmane (7mg/mL in CHCl3:MeOH, 2:1, TM-sprayer) and analysed using the RapifleX MALDI Tissue Typer™ at 50 µm.
Results: Acquired spectra were used to build a PCA and LDA-based classification models. The PCA analysis is used to decrease the dimensionality of the data sets and generate a list of features showing the largest variance within the data set. Further on, the features are subjected to supervised LDA through user assigned classes (cancer/normal/necrosis). These classes are usually defined based on tissue phenotypes delineated by a trained pathologist. The LDA is used for a second space transformation, in which it minimizes the intra- (within) class variance and maximizes the inter- (between) class variance. The cross-validation is performed by removing a part of the cohort and building the model again. A comparison of the classification models was made using an unsupervised CNN algorithm. Additional cross-validation was performed by mass spectrometry imaging.
Conclusion: The pipeline allows for rapid molecular detection, guided surgery and real-time analysis of esogastric cancer.


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Steroidomics Profile Analysis by LCHR-MS in Human Seminal Fluid

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 16:25

INTRODUCTION: Steroids play a crucial role in homeostasis of many biological processes including spermatogenesis, thus being responsible for some male infertility issues. Although steroids have been largely studied in many biological matrices (such as urine and plasma), there is very limited information of the steroid content in seminal liquid and its potential study as potential indicators of male infertility and other conditions.
OBJECTIVES: In this study, a LC-HRMS strategy has been developed in order to obtain the steroidomic profile of human seminal fluid.
METHODS: A comparison between supported liquid extraction (SLE) and solid liquid extraction (SPE) was carried out, and the chosen SPE method further optimized to map the largest possible number of compounds. Steroids were identified by using DynaStI, a publicly available retention time prediction webtool developed in our lab, to match the experimental data (i.e. accurate mass and tR).
RESULTS: Altogether these resources allowed us to develop a post-targeted approach able to consistently detect 40 steroids in seminal plasma (with half of them being androgens). Such steroidal profile was stable across different extraction times and injection days. In addition to accurate mass and retention time, the identity of 70% of the steroids detected in such steroidomic profile was confirmed by comparing their fragmentation patterns in real samples to those of standards. Finally, the workflow was applied to compare and distinguish the steroidomics profile in seminal liquid from healthy volunteers (n = 6).
CONCLUSION: In all, the developed steroidomics strategy allows to reliably monitor an extended panel of 40 steroids in human seminal fluid.


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Nontargeted Metabolite Profiling of Human Lung Epithelial Cells (A549) with HILIC Mode UPLC HRMS: Silica Nanoparticle Mediated Cytotoxicity Effects

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 13:55

Non-Functionalized silica nanoparticles (SiNPs) are some of the widely used nanomaterial in diverse industrial sectors and nanoparticle based drug delivery applications. In industrial manufacturing environment SiNPs can possibly comes in contact with employees. Studies of cellular level toxicity effects of SiNPs in human cell lines are pivotal in the metabolite based biomarker discovery. Human lung epithelial cells (A549) are used to decipher the overall cellular level metabolic changes, non-targeted metabolite profiling with HILIC (hydrophilic interaction liquid chromatography) UPLC-HRMS method in a data dependent (DDA) mode was developed for this study. From the identified metabolome data and corresponding dysregulation in the metabolome of A549 biochemical pathways, our preliminary finding indicated 8 nm SiNPs elicit observable effects on the A549 cellular metabolism over larger SiNPs.The study identified some insights in early stage selective metabolite markers for nanomaterial related cytotoxicity in human cell line.Identified metabolites were annotated to pathways related to glutathione mediated detoxification, amino acid degradation, central carbohydrate metabolism and nucleotide metabolism with statistical significance (p < 0.01).

Introduction
Non-Functionalized amorphous silica nanoparticles(SiNPs) are used in nano material manufacturing and nanoparticle based drug formulation studies,they can possibly come in contact with humans via skin and inhalation routes. We have developed an untargeted UPLC HRMS method to assess cellular level metabolic dysregulation of SiNPs on human lung epithelial cells (A549).

Methods
A549 cell line control group and SiNPs (spherical 8, 80 and 120 nm dia.) as exposure groups were used in the metabolite profiling experiment. HILIC mode UPLC-HRMS positive and negative polarity methods were developed to acquire tandem MS data in a data dependent MS (DDA) mode.Pooled QC was used to monitor MS method and overall LC-MS hardware performance and method robustness. XCMS online (Scripps Research Institute) and Compound Discoverer 2.1 were used for metabolome MS data processing and statistical analysis.Retention time alignment based MS1 precursor peak areas were used in relative quantitation between experimental groups.The metabolite pathway annotation was carried out with KEGG and BioCyc pathway representation.

Results and conclusions
The 8 nm SiNPs tend to affect the cellular level physiology to a wider extend over larger SiNP exposure groups.Data analysis revealed significant changes in relative metabolome profiles, p-value < 0.01.Differential changes in metabolites were annotated to pathways of glutathione detoxification, glutathione redox reactions II, central carbon metabolism, amino acid degradation pathways and t-RNA re-charging.

Acknowledgements

Shyam Arvamudhan, PhD
North Carolina A and T University, Greensboro, NC.

Daniel Todd, PhD
Mass Spectrometry Facility
UNC Greensboro.


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Optimising Laser Assisted - Rapid Evaporative Ionization - Mass Spectrometry Imaging (LA-REI-MSI) for the Spatially Resolved Analysis of Faecal Metabolites

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 16:05

Faecal metabolomics allows for the non-invasive study of biomarkers in gastrointestinal (GI) disease. Current analytical techniques are limited in their applicability as they can lack in sensitivity (Nuclear Magnetic Resonance Spectroscopy) or require time-intensive sample preparation (Gas Chromatography - Mass Spectrometry). Here, we present the optimisation of LA-REIMS for faecal sample analysis and its implementation into a novel high-throughput application of LA-REI-MSI for the near-real time analysis and mapping of metabolites in whole fresh or frozen human faecal samples.

In this method development study, participants with no known GI disease were recruited. Faecal samples were obtained, homogenised and prepared for faecal sample and faecal water (1:2 faeces: water) analysis using LA-REIMS in negative and positive ionisation modes. Faecal LA-REIMS was optimised in terms of laser and REIMS parameters to identify settings yielding the highest signal-to-noise ratio with least % carry-over between samples and smallest time interval between burns. The LA-REIMS optimisation was implemented in the LA-REI-MSI pipeline as a tool for direct-from-sample analysis with minimal sample preparation: Whole faecal samples (<1 hour of bowel evacuation) were segmented into cross-sectional plates (5mm) and analysed at 1 mm resolution. Pre-processing of data and statistical analysis in R Studio (V1.0.44) allowed for targeted or untargeted analysis. The highest relative intensity metabolites were carefully examined, and tentative fatty acid (FA) identification was carried out according to accurate mass and previous literature.

Based on the homogenised faecal sample of nine volunteers, optimized faecal LA-REIMS parameters were identified. The optimised settings demonstrate improved signal-to-noise ratios with decreased % carry-over between samples and were implemented in the LA-REI-MSI pipeline. Faecal samples from two healthy volunteers were investigated using LA-REI-MSI by visualizing the relative abundance and spatial distribution of metabolites. In the FA region, the most abundant peaks at m/z 255.24, 281.25, 279.25 demonstrate unique spatial distribution patterns and were putatively identified as palmitic acid, (18:1) FA, and (18:2) FA, respectively. In the m/z 600-1000, complex lipid species, which may hold utility in GI disease diagnostics, demonstrate heterogeneous distribution patterns. The heterogenous nature of key metabolites in faecal samples is an important consideration for faecal sample collection and processing before analysis. We are now performing observational studies in patients with colorectal cancer to determine potential biomarkers and their spatial distribution in faeces and targeted microbiome analysis of faecal microbial communities present.

The mapping of metabolites through faecal LA-REI-MSI is the first MSI technique to be used for the investigation of faeces and demonstrates clear application for biomarker discovery.


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The Use of Rapid Evaporative Ionisation Mass Spectrometry (REIMS) as a Real-Time Bedside Test in Cervical Cancer Screening

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 08:30

Background / Objectives: Cervical cancer is the 4th most common cancer among women while its incidence is expected to rise by 43% in the UK by 2035 (Cancer Research UK, 2019). The microscopic examination of cervical cells currently carried out to screen asymptomatic women is prone to human error and can lead to high numbers of false-positives and false-negatives. Primary HPV DNA testing has been shown to be more accurate in screening and therefore is projected to replace cytology in the UK by the end of 2019 (Rebolj et al., 2019). Rapid evaporative ionization mass spectrometry (REIMS) is an innovative technique that allows interrogation of biological samples without any need for laborious sample preparation. Our main objective is to establish whether REIMS can be employed for the detection and grading of pre-invasive cervical changes. We also seek to assess the ability of REIMS to distinguish women with high-risk HPV (hrHPV) infection from women without infection.

Materials and Methods: Cell pellet from liquid-based cytology (LBC) samples has been analysed with REIMS. During REIMS, laser energy is directed to the sample of interest and rapid heating results in a vapour containing gas phase ions. The generated ions are introduced into a spectrometer and a mass spectrum with molecular information is produced. Samples from more than 400 women, with recorded hrHPV genotype and cytological / histological results, have been used. The derived mass spectra are used to differentiate between women with precancerous changes as well as those being hrHPV positive and negative.

Results: Our preliminary results show that REIMS can predict the presence and grade of disease with higher accuracy than current cytology. The diagnostic accuracy of REIMS was also comparable to the gold-standard HPV genotyping.

Conclusions: Using a near-real-time, bedside technique such as REIMS would reduce cost, repeated visits and prolonged waiting times, benefitting both clinicians and patients.

References
Cancer Research UK.
Rebolj M, Rimmer J, Denton K, Tidy J, Mathews C, Ellis K, et al. Primary cervical screening with high risk human papillomavirus testing: observational study. BMJ 2019; 364: l240.



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Exploring the Volatomic Fingerprinting of Breast Cancer Tissue as an Untargeted Approach to Identify Potential Biomarkers

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 15:10

Introduction: Cancer is the second leading cause of death globally and is estimated to account for 9.6 million death in 2018 (WHO). Breast cancer (BC) remain the most common cancer in women and is ranked as the fifth amongst all cancers followed by colorectal, lung, cervix, and stomach cancers. The late diagnosis, using invasive and expensive procedures and the critical lack of medical and laboratorial infrastructures in the developing countries, are certainly two key contributing factors for this scenario. Therefore, more sensitive and specific diagnostic methods are urgently required.
Objective: The aim of this study was to explore the potential of the volatomic fingerprint of BC and breast cancer-free (BCF) tissues (n=30) from the same patients, to identify a set of endogenous volatile organic metabolites (EVOMs) potential BC biomarkers which might be used together or complementary with the most common BC diagnostics strategies.
Method: Tissue samples were thawed and 100 mg were weighted into 20 mL vials to which was added 17 % NaCl (w/v), 1000 µL of ultrapure water, 100 µL of the internal standard. The pH was adjusted to 2. The SPME fiber was introduced and exposed into the headspace for 75 min at 50 °C under agitation (800 rpm). The SPME fiber was removed from the vial and inserted into the GC injection during 10 min at 250 °C, separation on GC and identification by MS.
Results: Twenty-nine metabolites, belonging to several chemical families, were identified. Multivariate statistical analysis revealed some metabolites significantly altered in BC patients. Limonene, decanoic acid, acetic acid and furfural showed the highest sensitivity and specificity to discriminate of BC and BCF tissues (VIP >1, p < 0.05). The discrimination efficiency and accuracy of BC tissue metabolites was ascertained by ROC curve analysis that allowed the identification of some metabolites with high sensitivity and specificity. The metabolic pathway analysis indicated that the discriminatory metabolites could be originated from several dysregulated pathways in BC such as those involved in pyruvate and sulphur metabolism, and limonene degradation.
Conclusion: The obtained results suggest the possibility to identify endogenous metabolites as a platform to discover potential BC biomarkers and paves a way to investigate the related metabolomic pathways to improve the diagnostic tools of BC.
Acknowledgements: This work was supported by FCT-Fundação para a Ciência e a Tecnologia (project PEstOE/QUI/UI0674/2019 and INNOINDIGO/0001/2015), Madeira 14-20 Program (project PROEQUIPRAM - Reforço do Investimento em Equipamentos e Infraestruturas Científicas na RAM - M1420-01-0145-FEDER-000008) and by ARDITI-Agência Regional para o Desenvolvimento da Investigação Tecnologia e Inovação through the project M1420-01-0145-FEDER-000005 - Centro de Química da Madeira - CQM+ (Madeira 14-20). Catarina Silva acknowledge the FCT for the PhD grant (SFRH/BD/97039/2013).


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Potential of TiO2 Nanoparticles for Mass Spectrometric Detection and Quantification of Biologically-Relevant Small Molecules

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 15:10

INTRODUCTION: Matrix-assisted laser desorption and ionization mass spectrometry (MALDI MS) is suitable for clinical applications because of its performances. On the other hand, if organic matrices are used, analysis of small molecules (mass <1000 Da) becomes difficult due to a high number and intensity of matrix –related signals. Certain physiologically important molecules, such as hormones, carbohydrates, drugs, and others, belong to the small molecule group. Application of TiO2 nanoparticles as substrates for surface-assisted laser desorption and ionization (SALDI) MS is, in these cases, promising tool.
OBJECTIVES: To test the suitability of TiO2 nanoparticles with various sizes and shapes as substrates for SALDI MS of various classes of small biologically-relevant molecules.
METHODS: The following TiO2 nanoparticles are prepared: colloidal nanoparticles (NPs, round, diameters of 5 nm), prolate nanospheroids (PNSs, 40-50 nm length) and nanotubes (NTs, approximately 100 nm long, 10 nm diameter). Samples (amino acids, steroid hormons, vitamins, carbohydrates) at various concentration were analyzed in positive and negative mode, whereas reproducibility and day-to-day repeatability was tested by ANOVA statistical analysis.
RESULTS: By tested organic matrices, 63% of samples could not be detected, whereas by using any of nanoparticles, only 33% of analytes were not detectable. The spectra acquired with TiO2 nanoparticles, were characterized by lower number of well defined signals, which did not overlap with the signals from analytes. Analyte signals are simple, and the number of analyte-generated adducts is low when TiO2 substrates are used. Moreover, in some cases, also molecular ions could be detected. Generally, spectra were better reproducible when acquired with nanoparticles compared to organic matrices, as judged by the standard deviations in the signal-to-noise ratio (standard deviations are smaller when nanoparticles are used). In that sense, PNSs demonstrated the best properties compared to other shapes. Also, NTs showed better properties compared to colloidal nanoparticles. Finally, increased concentrations of NaCl in the nanoparticles` did not affect the spectra properties.
CONCLUSION: Having all results in mind, we can conclude that TiO2 PNSs have a great potential to be used as the “universal MALDI matrix” for analysis and potential quantification of metabolites in biological fluids.

Acknowledgements: Authors acknowledge funding of the Serbian Ministry of Education, Science and Technological Research (Grant No. 172011), FCT through CQM Strategic Project PEst-OE/QUI/UI0674/2019, IDR and Madeira 14-20 Program through the project PROEQUIPRAM – Reforço do Investimento em Equipamentos e Infraestruturas Científicas na RAM – (M1420-01-0145-FEDER-000008) and ARDITI – Agência Regional para o Desenvolvimento da Investigação Tecnologia e Inovação – for the support through the project M1420-01-0145-FEDER-000005 – CQM+ (Madeira 14-20 Program).


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MALDI Chip Technology for in situ Detection of Human Procalcitonin

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 14:50

INTRODUCTION: Procalcitonin (PCT) is a 114 amino acids precursor of calcitonin produced by thyroidal C-cells and other neuroendocrine cells. PCT is clinically well recognized acute-phase protein biomarker, whose levels increase within 4 to 12 h upon stimulation. Compared to other sepsis markers, PCT could distinguish between infectious and non-infectious systematic inflammation or between viral and bacterial infections. Serum concentrations of PCT can vary from 0.1 ng/mL in healthy individuals to 120 ng/mL in patients with acute septic shock. In this study we show a technology for fast in-situ enrichment and mass spectrometry detection of PCT in human serum. The presented technology allows preparation of MALDI compatible protein chips by ambient ion landing. The electrosprayed proteins immobilized on conductive surfaces allow a wide range of bioanalytical assays. Compare to other materials, non-reactive surfaces suffer minimal nonspecific interactions with chemical species in the investigated sample and are thus an ideal substrate for selective protein chips. The reaction takes place directly on the protein chip and is followed by in-situ analysis by MALDI mass spectrometry.

OBJECTIVES: The objective of this study was to identify a low abundant PCT using in-situ MALDI chip technology.
METHODS: For detection of PCT, MALDI chips were prepared by functionalization of indium-tin-oxide glass using ambient ion landing of electrosprayed anti-procalcitonin antibody. Because of low levels of PCT in human serum, fast pre-concentration procedure based on acetonitrile precipitation was used before in-situ enrichment of PCT on MALDI chips. One microliter of fraction containing pre-concentrated PCT was applied on the antibody-modified spots. After incubation, washing and matrix deposition, the PCT molecule was detected by MALDI-TOF mass spectrometer.

RESULTS: The effectivity of pre-concentration step to enrich PCT was tested by western blot analysis. The optimized ratio of serum/water/acetonitrile was 1:2:5 (v/v). The pre-concentration step enriched the PCT protein by factor of 30. The modified MALDI chips further selectively enriched the PCT molecule, which was observed in the MALDI spectrum as singly and doubly charged ion at m/z 14000 (1+) and at m/z 7000 (2+). The achieved limit of detection for PCT was 10 ng/mL with S/N ratio 14 for the doubly charged ion.

CONCLUSION: The results show the possibility to detect clinically important antigens at very low concentration levels by using combination of simple pre-concentration step, in-situ enrichment on functionalized surfaces and MALDI mass spectrometry. This opens the door to immunoMALDI assays that allow sensitive determination of antigens in serum and could lead to fast clinical assays that can be easily automated for high-throughput screening.


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Strategy for the Prediction of Neoadjuvant Therapy Response in Breast Cancer by MALDI-MSI

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 13:55

Introduction
Breast cancer is the most prevalent cause of cancer in women worldwide. Despite recent advances in the chemotherapeutic area, the response to therapy varies considerably from on patient to another. Responses can range from pathologic complete response (pCR) to non-response, with the progression of the tumor at worst. Predicting pCR non-invasively in breast cancer after neoadjuvant systemic therapy (NST) remains a challenge, as it can be difficult to visualize the tumor. Therefore, surgery remains the only treatment option; even when MRI scans show a pCR. Here, we investigate and demonstrate the ability of MALDI mass spectrometry imaging to predict the response to NST at an early stage of the patient’s management, from tissue biopsies taken before treatment.

Methods
Our study includes 27 female patients with invasive ductal carcinomas (tumor size ≥ 2 cm and/or lymph metastasis); who received 24 weeks of chemotherapy and/or immune therapy before surgery (i.e. NST). Biopsies were obtained during ultrasound before NST; and immediately fixed in formalin and embedded in paraffin. Tissue samples were prepared for MALDI-MSI analysis as follow: 1) sectioning into 5 um tissue sections; 2) deparaffinization and rehydration; 3) antigen retrieval and on-tissue tryptic digestion; 4) matrix application. MALDI-MSI experiments were performed on a Rapiflex Tissuetyper (Bruker, Bremen, Germany) operated in reflectron and positive ion mode in the mass ranges m/z 600-3000. Images were acquired at a spatial resolution of 50 x 50 µm2.

Results
One of the challenge with MALDI-MSI is to monitor complex sample preparation that allows analyzing FFPE tissue; as the analysis of clinical cohorts lies in the analysis of multiple samples over several days. Therefore, we developed a strategy which makes use of pork fat FFPE tissue assess and monitor on-tissue trypsin digestion efficiency, day-to-day variability (e.g. humidity, temperature) and experimental variability. PCA analysis of the pork fat data enabled to identify outliers and days where deviation in sample preparation hampered the analysis of the clinical samples. With this strategy, we were able to remove in a reliable way the BC samples with poor digestion from the analysis. After exclusion of outliers, a statistical model based on Partial Least Squares regression (PLS-DA) was built and allowed to classify samples pCR with a correct classification rate better than 95%.

Conclusion
We developed adequate quality controls to monitor the complex sample preparation process to analyze clinical cohorts by MALDI-MSI. With this strategy, we were able to reveal molecular (peptide) patterns able to classify breast cancer patient accordingly to their pathologic response to treatment.


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Successful Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection Associates with Decreased Complexity of the Serum N-Glycome

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 08:30

INTRODUCTION: Glycosylation is complex and highly abundant posttranslational modification of proteins that significantly affects their structure and activity. Glycans are directly involved in pathophysiology of every major disease and show great potential as clinical disease markers.

AIM: The aim of this exploratory study was to examine for the first time whether composition of the total serum and IgG N-glycome changes in response to faecal microbiota transplantation (FMT) for recurrent C. difficile infection (rCDI).

METHODS: The study included samples from two separate prospective clinical trials. Discovery cohort comprised a total of 227 sera from 76 patients at screening, 4 and 12 weeks post-transplant, while replication cohort included 110 sera from 55 patients before and at one time point after FMT. Total serum N-glycans and IgG Fc N-glycopeptides were analysed by HILIC-UHPLC and nanoLC-ESI-MS, respectively. Linear mixed modelling was used for analysis of association between glycan traits and FMT treatment.

RESULTS: Serum N-glycome was found to be significantly changed following FMT. Meta-analysis identified a number of consistent changes indicating a reduction in the complexity of the serum N-glycome. Specifically, post FMT samples had a higher relative abundance of low-branching, monosialylated and digalactosylated glycans, and on the other hand a lower abundance of high-branching, tri- and tetragalactosylated, and tri- and tetrasialylated glycans.

CONCLUSION: These findings are contrary to those consistently reported in chronic inflammatory states, where a more complex serum N-glycome pattern predominates. Changes in the complexity of N-glycans in sera may be an important molecular mechanism by which FMT exerts its beneficial therapeutic effects in rCDI and could in part explain its success in IBD.


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Detection of Vancomycin-Resistant Enterococcus faecium Using MALDI-TOF Mass Spectrometry

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 14:50

Introduction: Differentiation between Vancomycin-Resistant and Vancomycin-Sensitive Enterococci (VRE and VSE) is of paramount important in the clinical microbiology laboratory for the correct management of infected patients.
Objectives: The goal of this study was to discriminate between Vancomycin-Resistant and Vancomycin-Sensitive Enterococcus faecium using MALDI-TOF Mass Spectrometry (MS).
Methods: Overall, 60 E. faecium isolates (20 isolates sensitive to vancomycin, 20 hosting the vanA and 20 the vanB gene clusters) were cultured overnight on Columbia agar + 5% sheep blood (bioMérieux, Marcy L'étoile, France). Small amounts of biomass from individual colonies were spotted on four spots of the MALDI plate and submitted to on-plate protein extraction with 100% formic acid. Two protein spectra from each spot was achieved and labeled as “Day 1”. Each isolate was subcultured again in the above-mentioned conditions and labeled as “Day 2” and “Day 3”. For these time points, colonies were again spotted x4 and 4 protein spectra were collected from each of them in the range of 2.000 to 20.0000 Da using Bruker Biotyper (Bruker, Bremen, Germany). Data was submitted to analysis using Clover Bacterial Analysis software (Clover Biosoft, Granada, Spain). All spectra were preprocessed by a pipeline of a) baseline subtraction, b) picking the 50 most representative peaks, c) peak alignment and d) TIC normalization. Finally, 3D PLS-DA analysis was applied to discriminate the different groups of isolates.
Results: The PLS discriminant analysis used was able to establish a clear separation between the three groups of Enterococci (Vancomycin-Sensitive, vanA- and vanB-gene cluster hosting isolates) providing a list of most relevant peaks, key for their discrimination. The 3D graph shows three well-discriminated groups, corresponding to each group of isolates. Furthermore, the PLS-DA analysis provides a metric to examine the relevance of each m/z value to differentiate the groups.
Conclusions: Our study shows that MALDI-TOF MS is a rapid, reliable and inexpensive tool for the detection of vancomycin-resistant E. faecium. Further studies are required in order to corroborate these preliminary results.


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Plasma Metabolomics Profiles Associated with Endothelial Health and Dysfunction and their Influence on Endothelial Metabolism

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 10:30

Background: Endothelial dysfunction (ED) contributes to diseases of the vasculature by influencing blood pressure, clotting and transport of fluids, nutrients and immune cells. Metabolic phenotypes associated with ED are not well characterized due to difficulties in assessing endothelial metabolism in situ.
Methods: We built a cell scale metabolic network model of endothelial metabolism (iEC2812) and applied it to infer endothelial metabotypes from i) plasma metabolomics data from 20 trauma patients vs. 20 controls and ii) ASGR1del12 carriers vs. controls to identify reactions associated with both dysfunctional and above normally healthy endothelium, respectively. Proposed changes in endothelial metabolism in situ were validated in endothelial cell models in vitro by metabolomics analysis of spent media and intracellular 13C glucose and 15N glutamine isotopologue analysis.
Results: Network analysis of plasma metabolomics data suggested that endothelial glycocalyx maintenance may contribute to endothelial dysfunction via altered flux into the hexosamine biosynthetic pathway. HUVEC monolayers titrated with physiological concentrations of catecholamines to induce endothelial dysfunction resulted in increased permeability and glycocalyx loss as verified by TEM, immunostaining and by permeability assays. A drop in the intracellular concentrations of the glycan precursors UDP-glucose and N-acetyl-glucosamine was observed. Isotopologue analysis supported lower turnover of glycocalyx intermediates and lower glycolytic and TCA cycle flux in dysfunctional endothelial cells.
Conclusion: Metabolic network analysis of three independent plasma metabolomics datasets highlighted the importance of glycan synthesis to endothelial health. Induction of endothelial dysfunction in vitro is accompanied by compromised glycan synthesis.


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The Combined Use of Lys-C and Trypsin Provides Better Digestion Efficiency for MS-based Protein Quantitation

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 11:40

INTRODUCTION: There is growing evidence that serum levels of apolipoproteins (apos) refines cardiovascular disease (CVD) risk assessment as compared to traditional blood-based lipid markers. Several research groups developed LC-MS strategies for quantitation of apos. An IFCC WG was recently established to set up a Reference Measurement System for 7 apolipoproteins. To this end the WG decided to develop a Reference Measurement Procedure using peptide-based primary Reference Materials and bottom up proteomics strategy. This strategy requires equimolar digestion of proteins to peptides to ensure metrological traceability, which is particularly challenging for apos C-I and C-III. The combined use of Lys-C and trypsin improves digestion for protein identification, but has not been evaluated for protein quantitation yet. Here we present the use of Lys-C in combination with trypsin to achieve equimolar digestion of apolipoproteins for bottom up proteomics quantification.
METHODS: A multiplex LC-MRM-MS method was developed, containing 29 peptides from apos A-I, (a), B, C-I, C-II, C-III and E. Stable isotope labelled peptides were added to serum samples (0.4 µL) and apos in human serum were denatured and reduced in the presence of 0.33% (w/v) DOC and 23 mM TCEP. Upon alkylation with 4.6 mM IAA, serum proteins were digested with 0.8 µg Sequencing Grade Modified Trypsin for 3 h at 37°C. Peptides were enriched using Oasis HLB solid phase extraction prior to LC-MRM-MS analysis. For digestion optimization, 0.28-0.02 µg of Mass Spec Grade Lys-C were added 2, 1 or 0.5 h prior to the initiation of trypsin digestion. Moreover, the amount of trypsin was optimized. Relative responses (RR) were calculated at digestion times of 0, 1, 3 and 21 h.
RESULTS: Compared to trypsin-only digestion, addition of Lys-C 1 h prior of trypsin is advantageous and results in faster digestion and higher peptide yields. Digestion of 0.4 µL serum with 0.12 µg Lys-C with 0.6 µg trypsin resulted in stable plateaus for all peptides after 3 h digestion time. Compared to trypsin-only digestion, peptide yields increased 100% for peptide EFGNT (apo C-I) and 55% for TPDVS (apo C-I), while increases 85% for GWVTD (apo C-III) and 45% for DYWST (apo C-III). Peptides from apo B(total) increased 0-50%, apo B100 peptides 0-20%, apo(a) peptides 10-50% and apo E peptides 0-10%. No significant differences in digestion were observed for peptides from apos A-I and C-II.
CONCLUSION: Lys-C (0.12 µg) added 1 hour prior to trypsin (0.6 µg) improved digestion efficiency in 5 out of 7 of apos in serum (0.4 µL) compared to trypsin-only digestion. This digestion protocol results in stable plateaus for apos A-I, (a), B, C-I, C-II, C-III and E after 3 h of trypsin digestion. The combined use of Lys-C and trypsin likely enables a common sample preparation protocol allowing multiplexed, MS-based standardization of 7 apos, although equimolarity of the digestion step still needs to be proven quantitatively.


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HILIC-LC-MRM-MS Enables the Quantitation of PSA and its Major Glycoforms to Improve Prostate Cancer Diagnostics

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 9:00

Introduction
Prostate cancer (PCa) is one of the most prevalent cancers in men. Serum PSA levels are used for (early) diagnosis of PCa, but the performance of this medical test is poor, with false positive rates of 56-73% [1]. Therefore, there is a need for better tests with improved clinical performance for early detection of PCa. PSA is a glycoprotein and altered glycosylation patterns, specifically α2,3-linked sialic acids on urinary PSA, were shown to be associated with PCa [2]. Therefore, inclusion of α2,3-linked sialylated glycoforms of PSA might improve clinical performance. Here, we develop an LC-MRM-MS method for quantitation of PSA and its glycoforms using HILIC to enable sialic acid linkage isomer separation.

Methods
An Agilent 1290 infinity LC system coupled to an Agilent 6495 QQQ-MS was used to develop a targeted LC-MRM-MS method for peptides and glycopeptides from PSA. Commercially available PSA isolated from human seminal fluid was reduced, alkylated and proteolytically digested by either trypsin or argC. MRM-transitions were developed and optimized for two peptides and the isomeric glycopeptides with glycan composition HexNAc4Hex5Fuc1Sia2. Three different HILIC columns were evaluated for their separation of sialic acid isomers and the separation conditions (buffer type, strength and pH) were optimized. Digestion efficiency of PSA was evaluated to achieve test robustness and improve analytical sensitivity.

Results
Two peptides were selected for protein quantitation, namely FLRPGDDSHDLMLLR and LSEPAELTDAVK for trypsin and FLRPGDDSHDLMLLR and KWIKDTIVANP for argC. For these peptides, three transitions were selected; for glycopeptides two oxonium ions (m/z 274, sialic acid – H2O, and m/z 366, HexNAcHex) were selected as fragment ions. Best separation of glycopeptide linkage isomers was achieved using a Waters BEH amide column, with optimal solvent conditions of solvent A: 10 mM AF pH 4.4 in water, and solvent B: 90% acetonitrile in 10 mM AF pH 4.4. In an LC gradient of 8 min, glycopeptides with two α2,3-linked sialic acids eluted at 6.0 min, while glycopeptides with two α2,6-linked sialic acids eluted at 6.2 min. Stable digestion of PSA, a prerequisite for true quantitative results, was reached within 30 minutes for trypsin, and within 3 hours for argC.

Conclusions
The here developed HILIC-based LC-MS method for the separation of PSA glycopeptide linkage isomers, specifically α2,3- and α2,6-linked sialic acids, demonstrates the feasibility of quantifying individual glycopeptide isomers and thus specific glycoforms of PSA. While further method development is required, the focus on specific glycoforms using a targeted MS approach as outlined here, provides the granularity necessary for the development of molecular tests for detection and monitoring of prostate cancer in this era of precision medicine.

[1] Lilja et al. Nat Rev Cancer, 2008. 8: p. 268-78.
[2] Yoneyama et al. Biochem Biophys Res Commun, 2014. 448: p. 390-6.


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Calibration and Metrology for Protein MS Tests

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Thursday at 13:15

Key take-aways:
- Knowledge of different types of calibration strategies
- Basic understanding of metrological traceability chain
- Importance of a defined measurand and implications of proteoforms

Description
Wouldn’t it be nice if a test result would be the same, independent of the laboratory or method that was used to obtain the test result? Accurate quantitation of proteins starts with proper calibration, and proper calibration starts with the correct internal standard. This session briefly discussed the selection of internal standards as well as some specifics of their use and role in calibration. Then, the development of a proper calibration strategy, specifically the choice of calibrators as well as how they can and should be anchored to achieve metrological traceability is outlined. The need for a well-defined measurand, specifically in light of the heterogeneity observed by multiple proteoforms, and the implications of heterogeneity for the development of calibration strategies will be explained.


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The End of Kozak Dogma: The Ghost Proteome

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 14:30

Introduction:
A mature mRNA is a molecule presenting three different ORFs displaying several alternative ORFs. Recently, alternative proteins (AltProt) were detected in human cells, although such a mechanism was considered as anecdotal in eukaryotes.

Objectives:
To increase the number of potentially identified alternative proteins, a combination of multiple algorithms was used using the peptide shaker software. We were able to identify 10364 alternative proteins and 857 phosphorylated alternative proteins. However, several questions remain: where do these Altprots localize, with which partners and what are their biological functions?

Methods:
To response to these questions, top-down proteomics, bridged with MALDI-MSI of intact proteins, was used on brain regions and gliomas. Cross-link experiments followed by systemic biological analyses that allowed association with biological tests were realized in order to associate the sub-networks identified with the functional physiology.

Results:
140 reference proteins including 10 Altprots were identified. Systemic biological analyses were performed on the identified proteins allowing association of sub-networks with functional physiology. Back correlation of the identified proteins with tissue localization was then performed by MALDI MSI. In glioma, several Altprots were identified that are linked to patient survival. Cross-link experiments revealed networks between Altprot and their references leading to the possibility of their involvement in tumor resistance. Among these Altprot, we identified Heimdall protein as an alternative protein in astrocytes, which shares sequence homology with the Variable light chain of Kappa immunoglobulin. It presents a signal peptide and can form a dimer and a natural nanobody. This protein presents in its sequence some parts that are not folded, which correspond to the unstructured protein region IDP, and form multimers when secreted. Interestingly, its invalidation transforms astrocytes and neurons.

Conclusion:
Several dogmas have been shattered. First, we have shown that a mature RNA can act as a template for several proteins. Second, these proteins have regulating function in translation and mRNA transcription. Among these proteins we discovered Heimdall Alternative proteins from astrocytes, which is a nanobody structure that regulates astrocyte phenotypes by modulating the maintenance of the pluripotency of embryonic stem cells. Taken together, we consider that a Pandora box is now open with this Ghost proteome.


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Investigating the Relationship between TRIM44 and P53 Metabolic Pathways in Human Colon Cancer Cells in a 3D Model, Using PTR-ToF-MS

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Wednesday at 9:00

Background: Colon cancer is the fourth most common cancer in the UK resulting in approximately 16,000 deaths per year (Cancer Research UK, 2019). Biomarkers capable of risk stratification or leading to targeted therapy are therefore necessary to promote prompt patient diagnosis and treatment. This raises the need to understand cancer related metabolic pathways, and subsequently identify diagnostic and prognostic biomarkers. Overexpression of the gene TRIM44 has been related with carcinogenesis in a variety of cell lines and biospecimens, emphasising its importance as a potential cancer biomarker. However, TRIM44 mechanism of action is not yet elucidated. At the protein level, TRIM44 is structurally similar to TRIM29, which was previously shown to interact with p53, a crucial cell cycle regulator, by mediating its nuclear export. Taking into consideration the structural similarity between TRIM44 and TRIM29, this study hypothesised that TRIM44 mediates its carcinogenic effects is via p53-related pathway.

Objectives: This project aims to i) identify volatile metabolites linked with p53 and TRIM44 cellular mutations and ii) to study the association between p53 and TRIM44 metabolic pathways in Human colon cancer cells (HCT116).

Method: To identify p53 generated metabolites in cell headspace, HCT116 cells, stably expressing differential levels of p53 (-/- p53, -/+ p53 and +/+ p53) are utilised. Cells are seeded on 3D collagen hydrogels which resemble the native environment of cells. High-throughput, online measurements of Volatile Organic Compounds (VOCs) are obtained from cell headspace using PTR-ToF-MS. Different cell concentrations and incubation times (0h, 8h, 16h, 24h) are used to assess optimal condition for VOC assessment. The same protocol is applied in HCT116 with differential expression of p53 (-/- p53, -/+ p53 and +/+ p53), upon knockdown of TRIM44. Metabolite identification upon TRIM44 knockdown is compared to wt TRIM44 HCT116 cell lines containing differential p53 expression levels.

Results: A novel and highly sensitive method, not requiring sample preparation, is developed and optimised to assess VOCs released in cell headspace, using PTR-ToF-MS. In particular, this project characterises metabolites linked with p53 and TRIM44 mutations in HCT116 cells. Subsequent result analysis and VOC comparison would define the relationship between p53 and TRIM44 metabolic pathways.

Impact: This study increases the understanding of TRIM44 mechanism of action in human colon cancer cells. Identification of volatile metabolites linked with p53 and TRIM44 mutations is a step closer to reaching the ultimate goal, the non-invasive characterisation of these mutations via VOCs in exhaled breath. Moreover, as TRIM44 has been shown to be important in a number of other cancers this knowledge will also benefit the wider research community.



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Analysis of Fentanyl and Metabolite in Clinical and Post-Mortem Samples

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 15:10

Introduction
Fentanyl is prescribed for the treatment of chronic pain, and is used as an adjunct drug during procedures requiring anesthesia. However, in 2016, fentanyl and its analogues were the most common cause of overdose deaths in the United States, with most of these overdose deaths due to illegal fentanyl. As part of the so called opioid epidemic, analysis of fentanyls places a huge strain in both clinical and forensic settings.
Objectives
The aim of this project was to develop and implement a fast and efficient method for the determination of fentanyl and its metabolite, norfentanyl, in clinical blood and urine samples as well as in post-mortem blood samples. A UPLC-MS, method utilizing a phospholipid depletion clean up method was developed, to ensure minimal down time which can result from analysis of complex clinical and forensic matrices.
Methods
Aliquots of blood or urine were pre-treated using Biotage Phospholipid Depletion Cartridges (PLD). Calibrators and controls were spiked using certified reference materials with calibrators ranging from 0.5-500 ng/mL and controls at 1, 75 and 300 ng/mL. To 100 L of blood or urine, 300 L of acetonitrile was added along with deuterated internal standards (200 ng/mL), then applied directly to the PLD cartridges. Once eluted, samples were evaporated under nitrogen and reconstituted in 90:10 water:methanol. Analysis was carried out on a LX-50 UHPLC, using a Restek Raptor biphenyl 2.7 micron 100 x 3.0 mm column with a QSight® 220 CR MS/MS in positive ion mode. A binary gradient of 5 mM ammonium formate in water and methanol, both containing 0.1% formic acid was used for a total run time of 7 minutes. Two ions were monitored for each analyte transition and one for the deuterated standards. Human clinical and post-mortem samples were analyzed as well as samples as well as rat femoral and heart blood samples obtained from a post-mortem redistribution study.
Results
The method was validated following parameters set by ASB Standard 036-Standard Practices for Method Validation in Forensic Toxicology. The method was successfully applied to human clinical and forensic blood samples, human clinical urine samples as well as rat femoral and heart blood samples taken at various stages of decomposition.
Conclusions
A sensitive, clean and accurate method has been developed and validated for the determination of fentanyl and its primary metabolite norfentanyl in a range of different type of blood samples as well as from human urine. The use of PDL cartridges allows for quick and efficient sample clean up and increased instrument up-time.


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Laser Desorption Imaging – Rapid Evaporative Ionisation Mass Spectrometry Platform for Tissue Imaging

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 14:50

INTRODUCTION: Mass Spectrometry Imaging (MSI) is an emerging technique in the field of histopathology which enables the capturing of molecular information of clinically important tissue samples, thus allowing the histological characterisation of tissues. Several techniques are currently available, for example Matrix Assisted Laser Desorption Ionisation, Secondary Ion Mass Spectrometry or Desorption Electrospray Ionisation, however all these techniques have some technical challenges (extensive sample preparation, sampling in vacuum or high voltage requirements). In this presentation a new technique, Laser Desorption Imaging – Rapid Evaporative Ionisation Mass Spectrometry (LDI-REIMS) is described as a new MSI technique suitable for the rapid analysis of a wide range of samples without any sample preparation and under ambient conditions.
METHODS: A Xevo G2-S QToF (Waters, Wilmslow UK) Mass Spectrometer equipped with a REIMS source was used for the experiments. A home built motorised 2D XY stage coupled with laser optics was used as a sampling platform for all imaging experiments. An Intelliguide CO2 laser (Omniguide, Lexington, USA) at 10600 nm, a Medley MF3003 Er:YAG laser (2940 nm) and an Opolette HE2731 OPO laser (Opotek, Carlsbad, USA) tunable between 2700 – 3100 nm was used to map the Infrared laser parameter space for the experiments. 12 µm fresh frozen and formalin fixed paraffin embedded (FFPE) pork liver, rat brain and cancerous human breast tissues (all obtained under ethical approval) were used as samples.
RESULTS: Initial experiment show that the molecular coverage of the LDI – REIMS is sufficiently large for proper analysis. A wide array of metabolites, small molecules, peptides and structure molecules (glycerophospholipids) were observed during initial experiments. Comparisons were made using different wavelengths and laser pulse width and found the optimal mobilisation wavelength to be at 2900 – 2950 nm, correlated with the absorption maximum of the water content of tissues. Pulse widths between msec and nsec range were tested, finding the shorter pulses to be better for mobilisation. The currently achievable imaging resolution of our system is 50 – 70 µm. The pulse width and resolution are under further optimisation/investigation.
Successful tissue imaging experiments were conducted on several different tissue types, for example human breast tumour, rat brain glioma and pork liver molecular images were successfully created. The molecular changes observed in the data correlate well with the histopathological status of different tissues. After optimisation of the system, FFPE tissue slides were successfully measured without any sample preparation or extensive washing steps. Combining this feature with the high automation ability of the LDI-REIMS could enable autonomous processing of huge FFPE tissue banks, gaining useful insight behind the molecular changes in cancer and other diseases.


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Real-Time Therapeutic Monitoring of Valproic Acid in Exhaled Breath

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 13:15

Title:
Real-time therapeutic monitoring of valproic acid in exhaled breath

Authors:
Singh K (1,2), Ziesenitz V (1), Usemann J (1), Frey U (1), Van den Anker J (1), Datta AN* (1), and Sinues P* (1,2)
* shared last authors

Affiliations:
(1)University Children’s Hospital Basel, University of Basel, Basel, Switzerland
(2)Department of Biomedical Engineering, University of Basel, Basel, Switzerland

Abstract
Background:
In the field of medicine, serum concentrations of drugs with a narrow therapeutic window, used to treat seizures, are measured to assure the most efficacious and safe way of treating every individual patient. This form of personalised medicine is called therapeutic drug monitoring (TDM). We have explored the possibility to measure and monitor drugs in exhaled breath (EB) with a suitable real-time analytical method, to perform completely painless and non-invasive TDM for a future clinical application especially in pediatric patients.
Methods:
We employed SESI-HRMS to obtain highly resolved EB mass spectra. We then statistically compared these EB mass spectra between patients taking antiepileptic drugs against controls (no drugs), to find potential EB-based bio-markers for drugs. We then trained and tested various regression models to predict serum concentration of drugs using selected features from EB mass spectra. All the data analysis was performed by custom MATLAB scripts.
Results:
Our data for valproic acid (VPA), an antiepileptic agent, showed m/z at 115.1118, 132.1384, 143.1065, and 160.1331 to be significantly increased among others in patients taking VPA than controls. We hypothesize that these features correspond to proton and ammonium adduct of C7H14O, and C8H14O2, all of which were previously shown to be elevated in response to VPA. Furthermore, using EB measurements we were able to predict serum concentration of both total (RMSE ~5) and free (RMSE ~1.5) VPA in an independent group of patients (test-set). In the near future, we will perform MS/MS on selected ions to confirm their identity using exhaled breath condensate.
Conclusions:
This work is a part of an ongoing study and it is too early to come up with a definite conclusion. However, we would like to highlight the following important findings: 1) It is possible to successfully measure EB in pediatric patients treated with antiepileptic medications; 2) Several differentially abundant ions between controls and epileptic patients for various drugs were visualized (Shown for VPA here), but the identity and clinical significance of these ions is yet to be determined; 3) Serum concentration of both total and free VPA can be reasonably predicted via EB-based SESI-HRMS analysis.


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Exploratory Metabolomics of Urine and Plasma to Identify Novel Pharmacodynamic Biomarkers in a Phase I Clinical Trial of AZD3965

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 15:10

INTRODUCTION: A key metabolic alteration in tumour cells is increased dependency on glycolysis, resulting in the production of lactate which is transported out of cells by monocarboxylate transporters (MCT1 & MCT4) which are therefore a therapeutic target in cancer. Current literature suggests that inhibition of MCT1 in preclinical models can constrain cancer cell growth in tumours with low MCT4 expression. To date the systemic pharmacodynamic effects of the small-molecule non-competitive inhibitor of MCT1, AZD3965, the agent of study in this first-in-class (FIC) trial CRUKD12/004, have not been fully characterised. Preclinical metabolomics studies conducted at Imperial College London indicated that AZD3965 exposure caused increases in lactate, ketone bodies (also MCT1 substrates) and citrate in blood plasma and urine independently of tumour burden and tumour expression of MCT1, and also caused decreases in fatty acids in blood plasma.

OBJECTIVES: To investigate whether blood and urine levels of key metabolic markers are modified by AZD3965 treatment with the aim to provide pharmacodynamic biomarkers of efficiency, understand mechanisms of toxicity and define toxicity biomarkers.

METHODS: For the exploratory metabolomics study, we used NMR spectroscopy of urine and plasma samples from 34 patients from the trial to specifically monitor lactate and other ketone bodies and in addition a metabolomics screen using a well-validated LC-MS/MS protocol (Biocrates AbsoluteIDQ p180 kit) on plasma.

RESULTS: Metabolomics screen of plasma and urine appears to correlate with AZD3965 exposure and especially total urinary excretion of lactate and ketone bodies offers proof of target engagement. This effect is not mirrored in plasma suggesting that this may be primarily a renal effect. Observed systemic metabolic effects of AZD3965 exposure appear to lessen with repeated dosing, suggesting a rapid adaptive response. Metabolomics profile offers insides in understanding the mechanisms of drug toxicity and the potential to define metabolic biomarkers to identify individuals which are more likely susceptible to adverse drug toxicity.

CONCLUSIONS: The present metabolic profiling study provided biomarkers of drug exposure, proof of target engagement and understanding of the mechanism of drug toxicity. These results contributed to the successful completion of the Part 1 of the trial and the subsequent Part 2 is currently underway.


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A Chromatogram Says a Thousand Numbers: Data, Decisions, and Directions

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 08:30

Introduction: Data review in a high-throughput clinical setting has traditionally involved the monotonous evaluation of every chromatogram at the expense of employees’ sanity. This review is as much art critique as data science, given the confidence to release a patient result more tangibly comes from placing eyes on picture of a chromatogram rather than a set of metrics. However, those eyes are looking for different things depending upon the reviewer, assay, day, week, month, and year, and may lead to inconsistency in data review and patient care. Further, the wealth of data from each patient that could provide insight into everything from instrument capacity to assay performance to personnel utilization remains largely unexplored.
To tackle these challenges, we employ the cloud-based software Ascent® (Indigo Bioautomation) to dynamically model peaks and apply mathematical rules to flag samples based on acceptance criteria for patient result release or repeat/re-extraction. After batch release, results are transferred to a secure Amazon Redshift Server, where the data is accessed for analysis using the R statistical programming language. This talk will describe our journey into the world of big data, what we have learned and where we want to go.
Methods: Once batch acquisition is complete, sample information from the batch is merged with assay-specific lot and level information and transferred to a SSAE-16 (HIPAA, SOX, PCI-DDS) compliant, secure data center with advanced physical and logical security controls provided by Amazon Web Services (AWS). The data is accessed on a desktop application using the RPostgreSQL package that allows seamless introduction into the Tidyverse library of packages (dplyr, ggplot2, forcats, lubridate, etc).
Results: Our clinical mass spectrometry lab processes ~500 batches a week across 29 separate assays and 21 instruments. This corresponds to up to 24 employees reviewing daily > 8000 unique samples, many of which have 2-4 chromatograms per sample per analyte, generating a dizzying array of data. To translate this data into a form that can be used to monitor and improve the quality and efficiency of our laboratory, we use three tools: (1) Dynamic queries to the AWS database by situation (2) automatic, static reports generated weekly and monthly and (3) interactive dashboards constructed using R/Shiny for dynamic analysis. This talk will focus on how we use these tools to answer questions like the following: Do data review team members avoid reviewing batches that have a high(er) flag rate (samples with problems?) How long does it take to review a batch once it is ready? Are instruments being used at their full capacity? How can we use this data to improve throughput? What do assay flags tell us about the health of an assay or instrument? How can we concisely view Calibrator and QC performance across 29 separate assays and multiple levels daily, weekly, and monthly?


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Rigorous Quality Management Enables Long-Term Robustness of MS-based Protein Quantitation

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Wednesday at 9:40

INTRODUCTION: Mass spectrometry (MS)is an emerging technology that finds its way into medical laboratories for quantitation of proteins and proteoforms. Due to the complexity of bottom up proteomics quality requirements should be met during both method development and implementation as a lab-developed-test in order to guarantee that MS-based tests are fit-for-clinical-purpose(1). We previously developed a multiplexed LC-MRM-MS test for serum apolipoproteins (apo’s)(2). To maintain stable test performance, test quality has to be managed. Here we present long-term analytical performance data of an MS-based apo test in the real world setting of a medical lab.
METHODS: An LC-MRM-MS method was developed for multiplex quantitation of apo’s (a), A-I, A-II, A-IV, B, C-I, C-II, C-III and E in agreement with CLSI C62A recommendations. The apo method makes use of automated tryptic digestion of serum proteins and subsequent detection of at least 2 proteotypic peptides/protein and 3 MRM transitions/peptide. Five value-assigned, native serum samples were used as external calibrators. Test results were traceable to WHO-IFCC reference materials for apoA-I, B, and (a) and to manufacturer’s working calibrators for the other apo’s. A System Suitability Test comprising of synthetic peptides was established and two serum pools were used as IQC material. CLSI-EP15 validation demonstrated that all nine apo’s could be measured with overall CVs between 2.5 and 7.3 %. Both IQC samples were analyzed (3x) on each of the 96-well plates (n=70 runs) since July 2015 (3). The MS instrument was replaced after 12 runs, while an SPE-step was introduced after 37 runs to enable inclusion of medium abundant apo’s (a), A-II and A-IV. Trending of IQC results was monitored in Levey- Jennings plots.
RESULTS: IQC measurements remained within desirable analytical performance specifications over almost four years, independent of different technical operators, reagent lot variations or trypsin batches. Replacing the MS instrument did not significantly alter the results, nor did inclusion of an SPE-step. For the 23 peptides, measured CVs varied between 3.3 % and 11.5 % in all 70 runs.
CONCLUSION: This study indicates that long-term robustness of MS-based protein quantitation can be achieved through thoughtful method development in combination with stringent quality procedures as demanded by ISO15189:2012. This requires also properly trained staff, documentation of procedures, optimal maintenance of equipment, system suitability testing and checks for both precision and long term accuracy through IQC (and EQA when available). We demonstrate that MS-based tests for quantitation of proteins and their proteoforms perform stable in the setting of a medical laboratory and can be run with similar analytical performance as immunoassay-based tests.
1.Smit et al. TranslProteomics 2013;2,1.
2.van den Broek et al. Clin Chem 2016;62,188.
3.Ruhaak et al. Clin Chem 2018;64,747.


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The Predictive Potential of Salivary Proteomics for Characterization of the Phases of Allogeneic Hematopoietic Stem Cell Transplants

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 11:10

Introduction: For the past 60 years, the hematopoietic stem cell transplant (HSCT) has been successfully used as standard therapy for hematological disorders. After conditioning therapy, patients undergoing allogeneic HSCT present three phases of engraftment that occurs in different time points. The Pre-engraftment phase is defined by severe neutropenia, the next phase called engraftment occurs in the first 100 days after HSCT characterized by cellular immunodeficiencies and in the Post-engraftment phase the patients undergo an immune reconstitution of T cells, which normally occurs around 100 days or can take up to 2 years after allogeneic HSCT. Severe complications are associated with morbidity, mortality and malignances after allogeneic HSCT, which include effects in the oral cavity.
Objectives: The changes in the salivary composition after HSCT may contribute to identify additional specific tools that could indicate early prognostic factors. Here, we focused on the relationship between the differential protein expression and the progression of allogeneic HSCT.
Methods: Unstimulated whole saliva collected from patients undergoing allogeneic HSCT (n=20) in three time points, were analyzed by a LC/MS-MS. All proteomic data were correlated with the phases after HSCT and were subjected to bioinformatics analysis. Furthermore, we also analyzed the gene ontology terms, PANTHER and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment.
Results: To investigate the differences in the salivary proteins samples of the three groups, we clustered via Heatmap and profile plot (based on their proteins expression). The analysis revealed that the proteins involved in regulation of body fluids are the proteins with major variation among each phase and were classified in different molecular functions. The heatmap showed that in the pre-engraftment phase Alpha-2-macroglobulin, 78kDa glucose-regulated protein, Peptidyl-prolyl cis-trans isomerase, Fibrinogen gamma chain, Kininogen 1, Glucose-6-phosphate isomerase, Hemoglobin subunit beta and alpha-1-antrypsin proteins were differently expressed. A group of six proteins, including Apolipoprotein A-1, Profilin-1, A2M, HSPA5, HBB and SERPINA 1, showed different abundance in engraftment phase. In post-engraftment phase, higher abundance of FGG, Alpha-actinin-4, Clusterin, Fructose-biphosphate aldolase and Myeloblastin was observed.
Conclusion: In the current study, we found that the global nature of saliva proteomics also allows us to quickly assess the quality of group samples and entire studies based on disease progression focusing on innate immune response in mucosa, mucosal immune response and regulation of body fluids levels. Furthermore, we successfully measured proteins and possible biomarkers with potential application for targeted therapeutics, a promising future approach to risk stratification and better disease treatment modalities.


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Clinically Relevant Metabolites of the Human Gut Microbiota

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 8:50

INTRODUCTION: The human gut microbiota represents a pivotal environmental influence on the metabolism and overall health of the host. The immunomodulatory function of microbiota is mediated via the interaction of microbial metabolites with xenobiotic receptors expressed in immune cells and tissues. For instance, microbial catabolites of aromatic amino acids (i.e. tryptophan and tyrosine) were reported to activate pregnane X receptor (PXR) or aryl hydrocarbon receptor (AHR) in a ligand-specific fashion. The immune-metabolic homeostasis may be explored using quantitative metabolic profiling and targeted protein assays.

OBJECTIVES: The primary objective of this study was to determine the potential of specific microbial metabolites and inflammatory proteins as clinically relevant markers of pathology.
METHODS: Tandem mass spectrometry (MS/MS) assays were applied to biofluids and stool swabs using a triple quadrupole mass analyzer (selected reaction monitoring – SRM) for metabolic profiling of tryptophan, kynurenine and tyrosine pathways. SRM-proteomics assays were used for absolute quantification of inflammatory and immunological markers. The untargeted metabolic screening was performed using a high resolution/accurate mass (HR/AM) platform (Orbitrap Fusion, Thermo Scientific).

RESULTS: We have mapped the distribution of microbiota-associated metabolites within biofluids in adults, pregnant women, and neonates and linked them to levels of acute phase proteins. For instance, metabolites of human gut microbiota were quantitatively profiled in preterm premature rupture of the membranes pregnancies. Microbial indolepropionate was determined a reliable marker of adverse intra-amniotic conditions such as microbial-invasion of the amniotic cavity (MIAC). Next, we profiled microbial catabolites and inflammatory proteins in dried blood spots (DBS) and meconium/first stool swabs from neonates to establish signatures for microbial colonization acquired via vaginal delivery in comparison to Cesarean section.

CONCLUSION: The study has identified several metabolites produced by human gut microbiota as clinically relevant markers of dysbiosis or pathology. The functional characterization of microbiota is essential to understanding its role in immune homeostasis and human health.

ACKNOWLEDGMENT
This work was funded by the Grant Agency of the Czech Republic (project No. 17-24592Y), The Grant Agency of the Masaryk University (project No. MUNI/G/1131/2017), CETOCOEN PLUS (Ministry of Education, Youth and Sports e MEYS), (CZ.02.1.01/0.0/0.0/15_003/ 0000469) and by the RECETOX research infrastructure (MEYS), (LM2015051 and CZ.02.1.01/0.0/0.0/16_013/0001761).


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Impact of the New European IVD Regulation on Medical Laboratories - Opportunities and Challenges

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 14:30

The current regulatory rules governing in vitro diagnostic medical devices (IVDMD) in the EU are mainly represented by the European IVD directive dating back from 1998. This directive does not cover devices with characteristics related to newer techniques and applications in current in vitro diagnostic testing, lacks conformity with current international consensus with regard to the risk-based classification of IVDMD, lacks transparency with regard to the identification and labelling of IVDMD and lacks requirements for laboratory-developed tests (LDT).

To solve these and other shortcomings, the the current IVD Directive will be replaced by the new Regulation (EU) 2017/746 ("IVDR") which entered into force in May 2017 with a transition period of five years.

The scope of the regulation includes newer technologies such as, for example, POCT devices and companion diagnostics.

The classification of IVDMD according to the IVDR will follow new classification rules on the basis of a risk-based classification system including 4 risk classes: A (lowest risk class), B, C and D (highest risk class).

As consequence, the involvement of Notified Bodies in the conformity assessment of IVDMD will increase significantly in the future.

Manufacturers will be obliged to register themselves and the devices in a central European database (Eudamed). Of note, manufacturers of higher risk devices (Classes C, D) will be obliged to make publicly available a so called summary of safety and performance including key elements of the supporting clinical data of a device. This might increase the extent of information of device performance data that are currently often lacking in the perspective of medical laboratories.

The new IVDR requirements for LDT represent challenges for medical laboratories and interpretation of these requirements is necessary to guarantee adequate care for patient groups with specific needs in medical laboratory diagnostic testing.


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Shortgun Proteomics for Differential Diagnosis of HPV-associated Cervix Transformation

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 14:50

Cervical cancer is preceded by cervical intraepithelial neoplasia of different degrees of severity (low grade squamous intraepithelial lesion, LSIL and high-grade squamous intraepithelial lesion, HSIL). None of the routine tests allow to assess the risk of neoplasia progression which is very important for young women. Cervicovaginal fluid (CVF) is a valuable source of clinical information about the physiological and pathophysiological status of the female reproductive tract. The aim of this study was to investigate the features of the CVF proteome in HPV-associated transformation of the cervical epithelium.
CVF samples were obtained from 73 patients from 21 to 45 years with various forms of HPV-associated cervical lesions (LSIL, HSIL and cancer) and HPV-negative patients (NILM). CVF proteins were reduced; alkylated, precipitated in acetone with TFA and digested with trypsin. Tryptic peptide mixtures were separated on a nano-HPLC Agilent 1100 system using a self-packed capillary column by a 95-min gradient from 3% to 35% of ACN in water at a flow rate of 0,3 mkl/min. Mass-spectrometry analysis was carried out on a 7T LTQ FT Ultra (Thermo Electron, Bremen, Germany) instrument using a nanospray ion source (positive ion mode, 2.3 kV). Raw MS files were processed with MaxQuant software (version 1.1.1.2) against the SwissProt database.
A total of 675 proteins were identified with 1% FDR. PCA resulted in four distinct clusters in full accordance with the clinical diagnosis. Thus, CVF proteome proved to reflect the stage of cervical epithelium neoplastic process. To assess the changes in the proteome composition in HPV associated the neoplastic transformation of the cervix Welch’s t-test with Bonferroni correction (p<0.01) was performed. As a result 94 proteins showed significant changes compared to the NILM group.
The obtained CVF proteomic data was analyzed using the PLS-DA method to build a statistical model, allowing to differentiate severe dysplasia (HSIL, CANCER) from the mild/normal stage (NILM and LSIL). This non-invasive diagnostic approach is particularly important from a clinical point of view as it determines the treatment of patients. In a case of severe dysplasia (HSIL, CANCER) surgery is required, for LSIL periodically repeated examinations are more appropriate. A development set of 40 samples was used for PLS-DA model training. The proteomic composition of CVF demonstrated an excellent ability for mild/severe cervical neoplasia differentiation (R2=0.95, Q2=0.88). ROC analysis of the PLS-DA model built on the validation set of new samples (n=33) resulted in 77% sensitivity and 94% specificity at 0.48 threshold, with AUC equal to 0.87.
This data confirms high diagnostic potential of CVF proteome for cervical epithelium transformation stage determination.
This work was supported by the Russian Science Foundation project no. 18-75-10097.


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Rethinking Sex Steroids: Understanding the Clinical Relevance of 11-Oxygenated Androgens

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 08:30

The C19 steroid 11β-hydroxyandrostenedione (11OHA4) is a major product of adrenal steroidogenesis, but was ignored for decades due to an apparent lack of activity. However, recent studies have demonstrated that 11OHA4 is the precursor to the potent 11-oxygenated androgens, 11-ketotestosterone and 11-ketodihydrotestosterone, that bind and activate the human androgen receptor with affinities and potencies similar to that of testosterone and 5α-dihydrotestosterone (DHT), respectively. The significance of these findings becomes apparent when considering androgen dependent diseases such as castration resistant prostate cancer and endocrine conditions associated with androgen excess such as polycystic ovary syndrome and congenital adrenal hyperplasia. Recent findings pertaining to the importance of the overlooked 11-oxygenated androgens will be presented, highlighting the role of 11-oxygenated androgens in disease states and challenging the paradigm that testosterone and DHT are the only clinically relevant androgens.


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Multiplex Assay for Absolute Quantification of Inflammatory Proteins in 134 Meconium and First Stool Swabs from CELSPAC-TNG Birth Cohort Study

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Thursday at 15:10

Introduction: The early-life development of the immune system and a specific low-grade inflammatory response may be monitored via quantification of inflammatory protein markers. Activated neutrophils are associated with calprotectins (CAL1 and 2) and myeloperoxidase (MPO), thus elevated abundance of those proteins in stool indicates the response against pathogens or auto-antigens. Similarly, eosinophil-derived neurotoxin (EDN) and eosinophil cationic protein (ECP) are released into the intestinal lumen from eosinophils activated by food allergens. In this study, we have developed multiplex protein assay for the absolute quantification of inflammatory proteins (ECP, EDN, CAL1, CAL2, MPO, and A1AT) and IgA in meconium/first stool samples from CELSPAC-TNG birth cohort study.

Methods: Swabs were extracted into 50 mM ammonium bicarbonate buffer with 5 mg/ml sodium deoxycholate, proteins were reduced and alkylated, spiked with isotopically labelled peptides with trypsin cleavable tag, enzymatically digested with trypsin and desalted using SPE. Peptides were analysed by UHPLC/SRM-MS in positive ion mode.

Results: The multiplex assay was applied to 134 samples of meconium/stool swabs from neonates. Fecal levels of IgA2 were used to distinguish between samples of meconium (IgA2 levels < LOQ) and first stool (levels up to 493.0 µg of peptide/mg of total protein). Median of concentration of EDN was 52.4 ng of peptide/mg of total protein with the highest concentration 644.3 ng/mg and median of concentration of ECP was 24.9 ng/mg with the highest concentration 735.0 ng/mg. A positive correlation was observed between EDN and ECP (0.767) and between MPO and ECP (0.779) and EDN (0.667).
Samples were grouped according to the mode of delivery (i.e. vaginal delivery and Caesarean section) and levels of inflammatory proteins were compared. Levels of CAL1 and CAL2 were significantly higher in neonates delivered via Caesarean section. On the other hand, protein MPO was significantly higher in naturally born neonates. The different protein levels most likely reflect the diverse colonization dependent on the mode of delivery and the distinct development of mucosal gut homeostasis.

Conclusion: In this study, we have developed a multiplex assay for absolute quantification of inflammatory proteins in feces and applied the assay to 134 samples from CELSPAC-TNG birth cohort study. We have compared levels of inflammatory proteins in samples from newborns delivered via Caesarean section and by vaginal delivery and we have found significantly different abundances of MPO, CAL1 and CAL2.

Acknowledgement: This work was funded by Czech Science Foundation (GACR, 17-24592Y), CETOCOEN PLUS (MEYS, CZ.02.1.01/0.0/0.0/15_003/0000469) and RECETOX research infrastructure (MEYS, LM2015051 and CZ.02.1.01/0.0/0.0/16_013/0001761).


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Design of Experiments (DoE) – Get it Right from the Beginning

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Thursday at 15:45

INTRODUCTION: Method development for a quantitative LC-MS/MS method consists of several integrated steps involving many experimental factors which need to be simultaneously optimized to obtain maximum selectivity and sensitivity at minimum retention time. Optimization of experimental conditions for LC-MS/MS methods is usually performed by changing one-factor-at-time (OFAT) experiments. However, a much more effective optimization strategy for discovering important experimental factors and to optimize the responses is to utilize design of experiment (DoE). DoE is a systematic approach to data collection where all relevant experimental factors are studied simultaneously according to predefined plan. DoE can determine the individual and interactive effects of factors that can influence the output results of the measurements and estimate the optimum operating conditions for the LC-MS/MS method.
OBJECTIVES: The objective of this work is to illustrate how design of experiments (DoE) can be implemented for optimization of quantitative LC-MS/MS clinical diagnostic method.
METHODS: The chemometric approach DoE was used for optimization of an ultra-performance liquid chromatography (UPLC) coupled to an electrospray tandem mass spectrometry (MS/MS) platform for simultaneous quantification of cortisol, cortisone and glycyrrhetinic acid in urine and plasma. A fractional factorial design was used for experimental screening to reveal the most influential experimental factors. When multi-levels qualitative factors were included in the screening experiments D-optimal design was applied. Significant factors were studied via central composite design and related to sensitivity, resolution and retention time utilizing partial least square (PLS)-regression.
RESULTS: Results showed that many interaction factors were significant and therefore these variables could not be independently controlled to obtain optimal conditions. Baseline separation was achieved between the biomarkers and the method was implemented for analyses of human plasma samples from individuals with and without liquorices consumption for support of clinical diagnosis of liquorice induced hypertension and evaluation of 11 β-hydroxysteroid dehydrogenase type 2 (11βHSD2) enzyme activity.
CONCLUSION: This selected study shows that design of experiments (DoE) can be used to optimize the LC-MS/MS quantification method efficiently with only fraction of the experiments that would be required by changing one-factor-at-time (OFAT) experiments.


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UPLC-MS/MS-based Assays for Diagnosis and Therapeutic Monitoring in Patients with APRT Deficiency

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Wednesday at 9:00

Introduction
Adenine phosphoribosyltransferase deficiency (APRTd) is an inborn error of adenine metabolism, characterized by excessive production and renal excretion of a poorly soluble compound, 2,8-dihydroxyadenine (DHA) that leads to kidney stone formation and chronic kidney disease (CKD). Treatment with the xanthine oxidoreductase (XOR) inhibitors allopurinol and febuxostat reduces urinary DHA excretion and decreases stone formation. The aim of this study was to use UPLC-MS/MS-based assay for quantification of the biomarker DHA, metabolites involved in the adenine metabolic pathway and XOR inhibitors in urine and plasma samples for the purpose of improving the diagnosis and monitoring of pharmacotherapy in APRTd patients.

Methods
The UPLC-MS/MS assay was optimized by design of experiments (DoE) using the chemometric software MODDE 12 (Sartorius Stedim Data Analytics AB, Umeå, Sweden). D-optimal design was used for experimental screening of the variables and significant variables optimized with central composite face design (CCF) and related to sensitivity and resolution utilizing partial least square (PLS) regression.
Urine and plasma samples from APRTd patients (enrolled in the APRT Deficiency Registry and Biobank of the Rare Kidney Stone Consortium), both those receiving treatment with allopurinol or febuxostat and untreated patients, were analyzed as well as samples from heterozygotes and healthy individuals.
Protein and phospholipid removal plate was used for sample preparation of plasma samples (ISOLUTE® PLD+ Protein and Phospholipid Removal Plate, Biotage, Uppsala, Sweden) and urine samples were diluted 1:15 (v/v) prior to analysis.

Results, Discussion & Conclusions
Preliminary data from the UPLC-MS/MS plasma assay revealed that the DHA concentration in untreated patients ranged from 456-741 ng/mL and 27-130 ng/ml in patients treated with allopurinol. DHA was not detected in plasma samples from patients treated with febuxostat and in healthy controls. DHA was detected in all urine samples from untreated patients but not in any specimens from heterozygotes and healthy controls. The UPLC-MS/MS urinary assay revealed that DHA excretion in APRTd patients decreased from 75–289 mg in untreated patients to 13–112 and 10.0-13.4 mg with conventional doses of allopurinol and febuxostat, respectively.
Future work will focus on comparing the concentration of DHA, purine metabolites and XOR inhibitors in plasma and urine with the long-term clinical outcome of patients in order to establish a plasma DHA level and urine excretion of DHA that must be achieved in order to prevent new kidney stone formation and CKD progression in APRTd patients. Furthermore, the effect of the disease and the treatment on the adenine metabolic pathway will be investigated.


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Proteomic Analysis of Prostate Cancer Biopsies

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 9:20

INTRODUCTION: Cancer research is among the most studied areas of science and prostate cancer (PCa) is one of the most common types of cancer among men. Tissue samples, especially biopsies are often used in mass spectrometry based biomarker research as they have a great potential in understanding biochemical mechanisms underlying diseases such as cancer. Tissue microarrays (TMA) consist of several biopsies of different patients placed on a microscope slide.
The aim of our work was to develop and apply advanced nanoLC MS(MS) techniques to reliably identify specific proteins and cancer associated protein pathways from the surface of PCa TMAs (ca. 10 µg tissue).
METHODS: A previously published surface proteolytic digestion method was used for the sample preparation of the TMA cores, the glycopeptide enrichment was based on acetone precipitation; and these were followed by reversed phase nanoHPLC-MS(MS) measurements. For the data evaluation Scaffold, MaxQuant label-free quantitation and for protein pathway analysis STRING softwares were used.
RESULTS: The samples of normal, grade 1, 2, and 3 patients were compared in terms of identified proteins and the statistical changes occurring in the 100 most abundant common proteins between each groups. Several protein pathways were identified which change significantly and have already been presented to have crucial effects in prostate cancer progression. Besides, several unique proteins were identified some of which pose the potential as new biomarkers for diagnostics. Results on i) direct analysis of all the peptides after proteolytic digestion, and ii) the remaining peptides after glycopeptide enrichment were compared. The proteomics results obtained with and without glycoprotein enrichment pave the way for future utility of the methodology in combined glycomic and proteomic studies of TMA spots.
CONCLUSION: The presented TMA surface proteolytic digestion methodology and the glycopeptide enrichment step are extremely efficient and enable an alternative means of diagnostics supplementing histological analysis. The possibility to obtain bottom-up proteomics results after the enrichment of glycopeptides in the sample allows a higher level of structural characterization of biological processes. A further in-depth characterization is in progress in order to find specific proteins and pathways for possible diagnostics use.

ACKNOWLEDGMENTS: LT and KV are grateful for funding from the National Research Development and Innovation Office (NKFIH PD-121187 and NKFIH K-119459). LT and ÁR are grateful for support from the János Bolyai Research Scholarship of the Hungarian Academy of Sciences.


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Multiplexing Kidney Injury and Kidney Specific Biomarkers in Urine Using MS-based Bottom-Up Proteomics: A Robust and Feasible Approach

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 11:20

INTRODUCTION:Acute Kidney Injury (AKI) is a frequent complication in hospitalized patients. Early detection of AKI is an unmet clinical need because current markers are delayed markers of functional kidney loss. Early kidney damage biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinases 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) in urine are under investigation for early AKI detection and are typically measured by immunoassays. To increase specificity for kidney injury and to obtain information on the underlying pathology, kidney-specific proteins (e.g. uromodulin) and AKI biomarkers may be measured in a multiplex method. Here we aim to develop a multiplex LC-MRM-MS based method that is suitable for AKI biomarker quantitation.
METHODS:Urines from healthy individuals and from kidney transplant patients were collected, deidentified, pooled and stored at -80˚C till analysis. Samples were heated to inactivate urinary proteases and stable-isotope labelled peptides were added as IS. After denaturation, reduction and alkylation, proteins were tryptically digested and samples were desalted by HLB SPE. For immunoprecipitation (IP), antibodies on beads were incubated with urine. After elution, isolated proteins were digested. An Agilent 1290 infinity LC system coupled to an Agilent 6495 QQQ-MS was used to develop an LC-MRM-MS method for NGAL, TIMP-2, IGFBP7 and uromodulin. At least 3 candidate peptides were identified per protein by at least 3 fragments using product-ion scans and MRM transitions were developed.
RESULTS:Tryptic peptides from NGAL (ITLDEYWR, MYATIYELK, WYVVGLAGNAILR), TIMP-2 (EYLIAGK, FFACcamIK, IQYEIK), IGFBP7 (TELLPGDR, ITVVDALHEIPVK, DNLAIQTR) and uromodulin (YFIIQDR, VGGTMFTVR, VLNLGPITR) were identified. In one LC-MRM-MS run, all peptides from urinary NGAL, TIMP-2, IGFBP7 and uromodulin elute within 8 min. For LC-MS instrument monitoring, a system suitability test containing synthetic peptides and their labelled counterparts was developed with within- and between-run CVs <5% and carryover <1%. Direct protein digestion and LC-MRM-MS measurement from urine was hampered by urinary matrix effects. IP was needed for robust quantitation of TIMP-2 and IGFBP7 and the mean IP recovery was 85±1% and 97±4%, respectively. IP resulted in good measurement linearity (r2 = 0.99 at 0.5 – 15.5 fmol), precision (CV <5%) and S/N (S/N >100) for all peptides.
CONCLUSION:AKI biomarkers and kidney-specific uromodulin were included in a multiplex LC-MRM-MS method using bottom-up proteomics. Here we show that IP in combination with LC-MRM-MS allows accurate quantitation of low abundant proteins in the pmol/L range and overcomes urinary matrix effects. This strategy demonstrates the feasibility of developing an extended biomarker panel, in which the biomarker selection is guided by nephrologists’ unmet clinical needs, to enable early detection of AKI in hospitalized patients.


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KIMBLE: A Versatile Visual NMR Metabolomics Workbench in KNIME

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 10:50

INTRODUCTION: Processing and analysis of NMR metabolomics data typically involves a number of different software packages and that are partly controlled manually, limiting the reproducibility of the data processing workflow.

OBJECTIVES: Construct an integrated workflow that makes NMR data processing fully reproducible without sacrificing flexibility and extendability.

METHODS: A workflow was implemented in the free and open-source KNIME Analytics Platform, and distributed in the form of easy-to-install virtual machine. KNIME shows the workflow as a visually appealing graph that can be arranged by the user. With the choice for KNIME as a platform the user can extend the metabolomics workflow by making use of the large toolbox of data processing and machine learning tools that KNIME offers. R and Python scripts can be easily integrated in the workflow. Settings, algorithms and data are kept consistent; changes in the algorithms or setting lead to a reset of the results.

RESULTS: KIMBLE (the the KNIME-based Integrated MetaBoLomics Environment) offers a reproducible, flexible and extendible way of processing NMR metabolomics data. KIMBLE converts time-domain NMR data to a set of metabolite concentrations and complementary untargeted data and performs subsequent statistical analysis. Although adaptable to many kinds of mixtures, the published KIMBLE workflow is optimized for urinary metabolomics. Now KIMBLE has been optimized for serum/plasma NMR data as well, including the ability to import results from Buker IVDr analyses. Furthermore, KIMBLE is now fully integrated with the Human Metabolome Database (HMDB) and the Europe PMC scientific literature repository, opening interesting new alleys for data analysis. Examples for the use of KIMBLE for exercise-induced ketosis and polycystic kidney disease (PKD) will be shown.

CONCLUSION: KIMBLE is a comprehensive workflow for the conversion of raw NMR data into metabolic insights. By maintaining a tight connection between settings, algorithms and data, total reproducibility of the data processing is achieved.


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A Proposal to Standardize the Description of LC-MS -based Measurement Methods in Laboratory Medicine

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(Presenter)

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To be presented in Track 3 (Papageno Hall) on Wednesday at 9:00

Background: So far, most publications reporting mass spectrometry-based measurement methods intended for diagnostic use describe in detail the method realization in one individual laboratory site - showing a very limited level of abstraction

Methods: To overcome this limitation we suggest a standardized approach to reporting LC-MS based methods, differentiating between fundamental characteristics of a measurement method on the one hand; and variable characteristics on the other hand. In this concept, fundamental characteristics are those that can be essentially translated into separate realizations too - e.g. the mode of ionization (e.g., electrospray in positive polarity) or the m/z ratio of monitored ions. They are intended to define in their entirety the identity of a measurement method. In contrast, variable characteristics are those that cannot realistically be standardized over time and space – e.g. the lot of a chromatographic column or of solvents, or the instrument specific geometry of the ion source that is highly manufacturer dependent, as well as instrument tuning settings.

Results: We have developed a preliminary set of 35 fundamental characteristics – defining a measurement procedure generically; these also include well-defined essential system performance characteristics – e.g. the required mass resolution, or a signal readout for the lowest concentrated calibrant. Furthermore, we suggest a set of 15 variable characteristics – which should be documented for each individual implementation and analytical run to achieve methodological traceability of individual results.

Conclusion: We recommend this novel standardized approach to method description for discussion and evaluation in the community.


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Metabolomic Analysis of Human Atherosclerotic Plaques Reveals a Pathway of Foam Cell Apoptosis in Advanced Atherosclerosis

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 13:35

Introduction
Atherosclerosis remains a leading worldwide cause of mortality and morbidity. Advanced stenosing plaque can result to flow limitation or plaque rupture, leading to ischemic stroke or heart attack.

Objectives
The primary objective of this study is to provide a comprehensive in-depth elucidation of the metabolic dysregulations associated with atherosclerotic plaque deposition and identify potential novel targets and biomarkers for diagnosis and treatment tailoring.

Methods
Ultra-high performance liquid chromatography coupled to mass spectrometry (UHPLC-MS)-based metabolomics were utilized for the analysis of human advanced atherosclerotic tissue. From 78 patients, a total of 52 carotid and 26 femoral plaques were compared to 16 adjacent arterial non-plaque tissue (intimal thickening). Tissue samples were homogenised and extracted consecutively for aqueous and organic extracts. Aqueous extracts were analysed using hydrophilic interaction chromatography (HILIC-)UHPLC-MS, whilst organic extracts by reversed-phase (RP-)UHPLC-MS.
In vitro studies were performed using peripheral blood monocyte-derived macrophages (MDM) (from healthy volunteers). After one-week treatment with macrophage colony stimulating factor, MDM were treated with vehicle, acetylated-LDL (acLDL) and a combination of acLDL, soluble free unesterified cholesterol (FUEC) and Sandoz 58-035 (an acyl-CoA:cholesterol acyltransferase inhibitor). Using the vehicle and acLDL treatments as controls, the SAMD8 (the enzyme responsible for PE-Cer synthesis) gene mRNA was relatively quantified using real-time RT-PCR. Additionally, a flow cytometry cell death assay was employed to measure the levels of apoptosis and necrosis. Finally, cells from different treatments were extracted using organic solvents and analysed using a lipid profiling method (as described in the preceding paragraph).

Results
A panel of established as well as novel molecules, from several biological pathways, were identified as being dysregulated. These included FUEC, oxidized cholesteryl esters, purines, pyrimidines, sphingolipids and acylcarnitines. A previously unassociated sphingolipid, namely phosphatidylethanolamine-ceramide (PE-Cer), was detected with high statistical significance (p=9.8x10-12) and 2-fold reduction in plaque tissue. PE-Cer also demonstrated the highest (inverse) correlation to FUEC (ρ=-0.76).
In pilot validation studies, the acLDL/FUEC-treated MDM demonstrated elevated apoptosis, and a 2-fold reduction in PE-Cer, in concordance with the findings in human tissue. This was accompanied by a reduction of SAMD8 RNA. Finally, a comprehensive examination of the sphingolipid pathway demonstrated an increase in de novo ceramide synthesis, further to the recognised in apoptosis hydrolysis of sphingomyelin (to ceramide).

Conclusion
The PE-Cer pathway demonstrates a potentially pivotal role in advanced atherosclerosis, while previously unrecognised sphingolipid pathway alterations are revealed.


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Untargeted Steroidomics for the Identification of Novel Steroid Profiles in Dysregulated Steroidogenesis

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Thursday at 14:30

Introduction: There is a need to develop new diagnostic tools to diagnose and subtype patients with dysregulated steroidogenesis. Methods used today may require medication to be altered, multistep testing, imaging and even surgery to be able to make a final diagnosis. We hypothesize that it is possible to avoid many of these steps if the correct biomarkers or plasma steroid profiles are identified for patients suffering from these steroid dysregulation diseases, allowing diagnosis using only a single plasma sample.
Objective: Identify novel steroid profiles to diagnose and subtype diseases with a dysregulated steroidogenesis by the use of untargeted steroidomics on a UPLC-IMS-MS/MS platform.
Method: Steroid extraction is performed using positive pressure on a 96-well SPE column. The extracted compounds are analyzed in an untargeted approach on a Vion IMS-QTof (Waters) coupled to an Acquity I-Class UPLC (Waters). The samples are separated on a Cortex UPLC C18 column (2.1mmx100mm, 1.6µm) with a 15 min gradient. Samples are analyzed in both positive and negative mode within a mass range from 50-1000 m/z using MS-MS with a high collision energy ramping from 26eV to 56eV.
The resulting ions are searched against an internal library of 40 steroids (that is continuously being expanded), and against public databases so as to give identifications to the ions.
To be able to determine the correct identifications the method has several features allow for further refinement of the identifications. Ion mobility allows for the measurement of the cross collisional section (CCS) values of the compounds, giving us another physical parameter by which we can separate isobaric compounds from one another. The common fragmentation pattern of steroids in CID adds another feature that can be used to identify a compound as a steroid.
Conclusion: Most steroid dysregulation diseases can’t be identified or subtyped by measurement of a single compound. A plasma steroid profile is more likely to be the way forward. By measuring a large number of steroids, as this approach allows, machine learning techniques can be applied to the datasets and determine steroid profiles for the different diseases resulting in a simple diagnostic approach.
We are applying this methodology to a variety of patients with dysregulated steroidogenesis in an attempt to differentiate ACC from ACA, subtype Cushing’s and subclinical Cushing’s patients and subtype primary aldosteronism without the need for an adrenal venous sampling.


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Novel Glycopeptide Analysis Strategy for Prostate-Specific Antigen in Seminal Plasma of Infertile Men

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Thursday at 8:50

INTRODUCTION: Glycosylation is involved in many biological processes, one of these being fertilization. For example, literature indicates that alterations in N-glycan branching, sialylation and fucosylation are observed in seminal plasma of infertile males as compared to fertile males. While a causal relationship was not established, it is hypothesized that changes in glycosylation could disturb the normal course of fertilization. One of the major proteins in seminal plasma is the glycoprotein prostate-specific antigen (PSA). It acts as serine protease to liquefy seminal fluid by digesting seminal proteins, which results in an increased sperm motility. Moreover, it also plays an important role for the breakdown of cervical mucus and allows sperm to enter the uterus. A recent study screened seminal plasma proteins and revealed an up-regulation of fucosylation in subfertile men, which could be partially attributed to PSA. However, the exact role and effects of PSA glycosylation on male infertility is not yet clear.
METHODS: Novel high-throughput PSA glycosylation analysis methods with MALDI-TOF/FTICR-MS were established, which enables the discrimination of α2,3 and α2,6-sialylated isomers. In this study, we successfully applied the method on a sample cohort (N=100) consisting of seminal plasma from infertile patients and healthy individuals. Patient samples can be subdivided into four groups: normozoospermic (normal sperm parameters but infertile), oligozoospermic (low sperm count), asthenozoospermic (low sperm motility) and oligoasthenozoospermic (low sperm count and motility). Furthermore, a well-developed CE-ESI-MS/MS method is used to characterize novel glycan structures.
RESULTS: In total, 25 and 45 glycopeptides were identified in all samples by MALDI-TOF-MS and MALDI-FTICR-MS, respectively. All glycopeptides contained the same amino acid backbone (NK) and varied in their glycan composition and/or sialic acid linkages. Interestingly, PSA N-glycans from seminal plasma showed to be highly fucosylated and sialylated. In addition, mainly complex glycans were observed followed by hybrid-type structures and high mannose-type glycans. Studying derived glycan traits, including the level of fucosylation, sialyation, LacdiNAc and different N-glycan types of PSA glycosylation, no significant differences were observed between different groups.
DISCUSSION: Preliminary results of MALDI-TOF-MS revealed no changes in the PSA N-glycosylation between fertile and infertile males of the different groups. In other words, in contrast what has been suggested by other studies, PSA might not contribute to observed glycosylation changes in total seminal plasma. However, no direct conclusions can be drawn as the data-processing of the obtained data from high resolution MALDI-FTICR-MS data is still ongoing.


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Metabotyping Burn Injury Using UPLC-MS Coupled with Microdialysis

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 11:40

INTRODUCTION: Burn injury can be a devastating trauma, affecting millions of people worldwide, with long-term personal and social implications for patients. Burns can result in life-limiting chronic pain, often refractory to treatment. Mechanisms behind burn injury are poorly understood and there has been little research into the molecular basis of burns and subsequent pain. It is important to explore the local signalling environment, but studies are often destructive in nature and preclude the collection of longitudinal temporal data. Microdialysis is a sampling method allowing the in vivo collection of solutes primarily from the extracellular interstitium and is ideal for the study of burn injury. Metabolomics offers an unbiased approach to the elucidation of metabolites involved in pathological events. Coupled with mass spectrometry, it provides a sensitive platform for the detection of metabolic changes due to burn injury.
OBJECTIVES: Elucidation of altered metabolites due to burn injury - to enhance understanding of the pathological processes occurring and guide future therapeutic strategies.
METHODS: Subcutaneous microdialysis in a burn model was coupled with ultra performance liquid chromatography – mass spectrometry (UPLC-MS) analysis. Microdialysis was conducted for 0.5 hrs pre-burn and 3 hours post-burn, collected in half hour fractions for time series analysis. An Acquity UPLC system with a HSS T3 column was connected to a Synapt G2-S Q-ToF. Data were processed using XCMS software. Principal components analysis (PCA) was applied for unsupervised multivariate comparison of burn and control sites. Partial least squares discriminant-analysis (PLS-DA) was applied to rank metabolite features contributing to these differences. Model robustness was affirmed using CV-ANOVA. MS/MS studies for structural elucidation were performed using the same UPLC-MS system.
RESULTS: Hundreds of polar analytes and lipids were profiled from microdialysate samples over a reversed phase run of 12 minutes, yielding a high number of burn-altered metabolites. PCA scores plots showed tight quality control sample grouping, indicating acquisition stability. Clear metabolic differences were observed between microdialysates collected from burned tissue and the control sites. Two important molecules elevated in burn injury were structurally elucidated; niacinamide and uric acid. These two compounds are potentially involved in the pathology of burn injury.
CONCLUSION: This study demonstrates the application of high throughput metabolomic profiling to samples collected both continuously and specifically from the burn site. Further understanding the metabolic changes induced by burn injury will help to guide therapeutic intervention in the future. This approach is equally applicable to the analysis of other tissues and pathological conditions, so may further improve our understanding of the metabolic changes underlying a wide variety of pathological processes.


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Chemometric Strategies for Sensitive Regions of Interest Annotation in Complex Imaging Mass Spectrometry Data

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 8:50

Introduction
Imaging mass spectrometry (IMS) is used to visualize the spatial distribution of molecules on sample surfaces. In particular, matrix-assisted laser desorption/ionization (MALDI) IMS is a popular approach for studying biochemical processes related to disease pathology, pharmacotherapy and drug metabolism. Biochemical distribution maps obtained from the analysis of biological tissues can be matched to histological features, the technique has thus also been referred to as molecular histology.
A number of studies demonstrated the effects of data processing for interpretation and improved visualization of IMS data. Commonly, data processing methods are chosen based on rational motivations rather than comparative metrics and no quantitative measures to asses and compare processing options have been suggested. In here, we propose an approach to supply the demand for unbiased strategies to evaluate IMS data processing and its effects on multivariate image analysis including objective identification of histological ROI and associated chemical co-localizations.

Methods
We applied the MALDI imaging workflow as previously described. Briefly, fresh frozen brain tissue from control mice was cut into 12 μm thick sections in a cryostat microtome and collected onto conductive glass slides. The matrix was applied immediately prior to MALDI MS analysis using a dedicated matrix sprayer. For lipid analysis, 1,5-diaminonaphthalene was used as matrix. IMS data acquisition in negative ion mode was performed in reflector mode. Subsequently, the matrix was removed through ethanol washing for follow up H&E staining.
MALDI IMS data were processed in MATLAB (MathWorks). Evaluated spectral preprocessing steps included log10, ln and square root transformations along with their combination with common normalization methods including total ion current (TIC) normalization, median/mean normalization, root mean square normalization (RMS), and normalization to the maximum peak. Multivariate modelling was performed in SIMCA (Sartorius Stedim Biotech, Sweden).

Results & Discussion
Multivariate image analysis of the MALDI IMS date using principal component analysis (PCA) provided structural features. This in turn allowed precise segmentation of anatomical features on the PCA data scale using a region-based active contour segmentation algorithm. This class information was supplied to OPLS-DA modelling, which provided quality metrics i.e. predictive ability of OPLS-DA models to quantitatively compare the applied processing methods. Logarithmic transformation reduced the heteroscedastic noise structure of the data resulting in improved multivariate models and the visualization of even delicate anatomical features (i.e. Purkinje cell layer in cerebellum).


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Deep Urinary Volatile Organic Compound Profiling with Headspace Sorptive Extraction and GCxGC-MS for Oesophago-Gastric Cancer Detection

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 13:55

Introduction: There is a pressing need to develop new non-invasive screening tests for Oesophago-gastric (OG) cancer due to its high prevalence and poor survival. Previous studies have reported that urinary volatile organic compounds (VOCs) reflect human pathophysiological status. GC-MS based methods are the main approaches for urinary VOC profiling. However, biomarker discovery is limited by often inefficient and labour-intensive solvent extractions, by chromatographic resolution and by the unavailability of a complete, detailed, and high-throughput data-preprocessing methodology for large-scale untargeted VOC analysis of urine samples. Novel HiSorb sorptive extraction and conventional solid phase microextraction (SPME) are both tested and evaluated. GCxGC combined with TOF-MS is employed and offers outstanding identification capabilities. By coupling HiSorb/SPME with GCxGC-TOF-MS, this project aims to discover new predictive biomarkers for OG cancer.

Methods: Optimum extraction conditions are explored for HiSorb and SPME. Osmolality is measured for urine dilution correction; urinary VOCs are extracted using both techniques in parallel and are analysed in a GCxGC-TOF-TI-MS-FID system (Markes BenchTOF Select). A complete data pre-processing pipeline is developed, from sample aliquoting/quality control to batch correction/biological interpretation.

Results and Discussion: HiSorb shows potential advantages compared to SPME, including lower fragility, better reproducibility and VOC extraction. Osmolarity normalisation corrects the influence of urine concentration variation. Peak deconvolution/picking/identification is compared among various softwares. Reproducibility, blank contamination, instrument drift, run order and batch effects are estimated and corrected accordingly. Finally, the applicability of the method is tested in a pilot cohort of 70 patients.


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From Spectrometric Data to Metabolic Networks: An Integrated Quantitative View of Cell Metabolism

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(Presenter)

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To be presented in Track 1 (Mozart 1-3) on Wednesday at 9:00

INTRODUCTION: Metabolite profiling – or metabolomics – presents a powerful global approach to measure shifts in metabolites as functional readouts of cellular state. Metabolites can complement upstream biochemical information obtained from genes, transcripts, and proteins and advance our understanding of how cells are altered in health and disease. Unfortunately, the great success in the characterization of genes, transcripts and proteins has currently no parallel in metabolites. Metabolomic studies are revealing large numbers of naturally occurring metabolites that cannot be characterized because their chemical structures and spectrometric data are not available. This is preventing metabolomics from evolving as fast as other omic sciences, and thus it is restricting the integration of multiple layers of omic data to gain more insights into the emergence of observed phenotypes.
OBJECTIVES: To fill this gap, new experimental approaches based on mass spectrometry (MS), and innovations in bioinformatics to enable a comprehensive analysis of cellular metabolites are needed.
RESULTS: Here I will present novel computational tools for: 1) identifying and quantifying metabolites from reconstructed GC-MS, LC-MS and MALDI-MS spectral profiles; 2) the structural characterisation of unknown metabolites; and 3) the use of isotopically labeled metabolites to study the flow of chemical moieties through the complex set of metabolic reactions that happen in the cell. Finally, I will show that the integrated analysis of proteomics and metabolomics data through metabolic networks provides a new conceptual structure for an alternative quantitative and predictive description of cell metabolism.


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Robust Accurate Identification and Biomass Estimates of Microorganisms via Tandem Mass Spectrometry

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(Presenter)

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To be presented in Track 6 (Doppler Hall) on Thursday at 11:10

Rapid and accurate identification of microorganisms and their biomass
estimates are of extreme importance to public health and safety. Mass spectrometry
has become an important technique for these purposes. Previously
we published a microorganism identification method, MiCId v.12.26.2017, that
was shown to perform no worse than other workflows. We present in this talk
MiCId v.12.06.2018 that, in comparison with the earlier version v.12.26.2017,
provides an additional feature for relative biomass estimates, better interprets
analysis results, provides more accurate microorganism identifications,
and successfully reduces the number of false positives. This significant advance
is made possible by several new ingredients introduced: first, we apply
a modified expectation-maximization method to compute for each taxon
considered a prior probability, which can be used for relative biomass estimate;
second, we introduce a new concept called ownership, through which
the participation ratio is computed and used it as the number of taxa to
be kept within a cluster; third, based on confidently identified peptides, we
calculate for each taxon its degree of independence from the rest of taxa
considered to determine whether or not to split this taxon off the cluster.
Using a large dataset, we show that, in comparison with v.12.26.2017, version
v.12.06.2018 yields superior sensitivity and specificity. We also show that
MiCId v.12.06.2018 can estimate species biomass reasonably well. The new
MiCId v.12.06.2018 is freely available for download at https://www.ncbi.
nlm.nih.gov/CBBresearch/Yu/downloads.html.


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The Analysis of Alpha-1-Antitrypsin Glycosylation in HCC Patient Serum

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(Presenter)

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To be presented in Track 2 (Mozart 4-5) on Wednesday at 9:40

Introduction:
The change in glycosylation of some serum proteins is often associated with the development of various diseases and thus can be used for diagnosis. The traditional immunoassay-based method relies on a specific antibody, the quality of which is not stable from batch to batch, resulting in inaccurate qualification and quantification. In this study, a liquid chromatography-tandem mass spectrometry-based method is used for accurate qualification and quantification of a serum protein alpha-1-antitrypsin (A1AT) in early stage HCC and cirrhosis patient serum.

Methods:
Serum protein A1AT was purified from patient sera with anti-A1AT antibody conjugated agarose beads. Isolated A1AT protein was digested and analyzed by LC-MS/MS. The stepped HCD strategy enables the qualification of glycopeptides of A1AT and the parallel reaction monitoring (PRM) strategy is used to quantify various glycoforms of A1AT glycopeptides in HCC and cirrhosis patient sera. pGlyco2.0 software was used for glycan identification and skyline software was used for glycoform quantification using Y1 ion in MS/MS spectrum.

Results:
In-source dissociation was found to severely affect the identification and quantification of glycopeptides. Therefore, the settings of the mass spectrometer were optimized to minimize the in-source dissociation of glycopeptides, including RF lens, the temperature of ion transfer tube, and capillary voltage.
We identified 11 glycopeptides A1AT with stepped HCD, 7 of which were quantified using PRM among patient samples. We found PRM strategy was able to distinguish several isomers of the glycopeptide. Several isomers showed specific pattern in some HCC patients. We also found that the ratio of different charge states of one glycopeptide of A1AT can significantly discriminate early stage HCC from cirrhosis.

Novel Aspect:
This methodology can be applied to identify and quantify glycosylation of any key glycoprotein in various diseases.


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Validation of a Rapid LC-MS/MS Method with Simple Solid Phase Extraction for Analysis of Catecholamines and their Metabolites in Plasma

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(Presenter)

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To be presented in Track 4 (Paracelsus Hall) on Thursday at 13:15

Introduction
Catecholamines[epinephrine(E), norepinephrine(NE),and dopamine(DA)] along with their metabolites [metanephrine(MN), normetanephrine(NMN), and 3-methoxytyramine(3-MT)] play important roles in humans as neuromodulators and hormones in the blood circulation. Their extremely high levels can indicate the presence of neuroendocrine tumors. Accurate and rapid quantitation of catecholamines is useful in the differential diagnosis of neuroendocrine tumors.

Methods
200 μL plasma were firstly diluted using isotope labelled internal standards(IS), and then extracted using solid phase extraction. The performance of the isotope diluted liquid chromatography tandem mass spectrometry(ID-LC-MS/MS) was thoroughly evaluated. The method was applied for evaluating the level of catecholamines and metabolites in 73 apparently healthy adults.

Results
The total analysis time of the method was 4 mins. The ID-LC-MS/MS method was highly sensitive, with an limit of quantification(LOQ) for E, MN, NMN, 3-MT, and E of 1 pg/mL, and an LOQ for DA of 5 pg/mL, and NE of 10 pg/mL. After correction using IS, no significant matrix effects were observed. Good reproducibility was obtained, with total CVs of 3.2-13.1%,4.8%-10.0%, 6.2%-6.9%,3.8%-7.9%,4.1%-8.8%,3.4%-8.9% for DA, E, NE, MN, NMN, and 3-MT, respectively. Recoveries were in the range of 91.1 to 109.7% for the six analytes. The mean levels of MN, NMN, 3-MT, DA, E, and NE in the volunteers were 22.9±7.2 pg/mL, 41.4±17.2 pg/mL, 2.34±2.01 pg/mL, 10.2±4.6 pg/mL, 29.3±14.2 pg/mL, and 427.0±190.6 pg/mL, respectively.

Conclusions & Discussion
A reliable ID-LC-MS/MS method for the determination of catecholamines and metabolites using small volume of plasma was verified. The method is quick, simple, could serve as an essential diagnostic tool for neuroendocrine tumors in clinical practice.


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Whole Blood Omega-3 Index by Gas Chromatography Dependence on Age and Gender in Caucasian Population

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(Presenter)

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To be presented in Track 5 (Trakl Hall) on Wednesday at 9:40

Introduction: Fatty acids (FA) - organic compounds belonging to the group of carboxylic acids, the molecules of which contain a different number of carbon atoms (from 10 to 20). FA are divided into saturated (only single bonds), monounsaturated (with one double bond), and polyunsaturated (with several double bonds). The Omega-3 Index reflects the relative amount of omega-3 FA within red blood cell membranes. Many studies show that a low Omega-3 Index is associated with increased risk of cardiovascular disease (CVD), and it has been proposed that raising the index may help to reduce CVD risk. Measurements of FA in red blood cell membranes can provide important information about FA intake. In different regions of the world the value of the Omega-3 Index in the population varies considerably due to the peculiarities of nutrition. The purpose of this study was to identify the effect of age and gender on the Omega-3 Index in the average Caucasian population.
Materials and methods. Whole blood samples were obtained from 4362 people aged 20 - 70 years old (1395 males and 2967 females). The content of FA in the blood was determined by using gas chromatography (GC) with flame ionization detector. The method involves the preliminary derivatization by acetyl chloride followed by extraction with hexane. Omega-3 Index for whole blood (EPA + DHA to total content of FA) is expressed as the percentage.
Results. It was found that the value of Omega-3 Index increases from 20 years (4.39%) to 50 years (5.38%). After 50 years the magnitude of the flex begins to decrease gradually. Depending on gender the average Omega-3 Index in men was lower than in women, respectively 4.75% versus 5.08%. The total sample by age was divided into decades. In all age groups for women the index value was higher. The highest Omega-3 Index was observed in both men and women in the period from 30 to 69 years.
Conclusions. According to the data obtained it can be concluded that the value of the Omega-3 Index corresponding to the greatest risk of CVD occurrence is observed in age periods of 20–29 years and after 70 years. The study revealed a clear dependence of the Omega-3 Index on gender and age, which requires clarification of target values for this marker of the risk of CVD.


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Determination of Serum Triglyceride by Isotope Dilution LC-MS/MS

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To be presented in Track 5 (Trakl Hall) on Wednesday at 9:20

Background: There are some reference methods to determine serum total glycerol and triglyceride all by isotope dilution gas chromatography mass spectrometry which are time consuming and complicated. A need exists for a simple reference method that can be easily adopted to verify the accuracy of serum triglyceride measurements, especially with different measurement principles. Just as serum triglyceride concentrations are generally determined from total glycerol with or without a subtraction of free glycerol. So candidate reference methods involving isotope dilution liquid chromatography tandem mass spectrometry (ID-LC/MS/MS) for total glycerol and free glycerol were established. The triglyceride concentration was the difference between total glycerol and free glycerol.
Methods: An isotopically labeled internal standard, [13C3]-glycerol, was added to serum, protein precipitation, and derivatization by benzoyl chloride to prepare samples for LC/MS/MS analysis using electrospray for ionization (ESI). For total glycerol, hydrolysis was conducted after adding the internal standard. For separation, a Nova-Pak C18 column was used with a mobile phase consisting of 10 mmol/L ammonium formate in water–acetonitrile (20:80 by volume) for positive ions. The quantitative ion transitions of [M+NH4]+ at m/z 422.2→283.2 and m/z 425.2→286.2 were monitored for glycerol and [13C3]-glycerol, respectively. The qualitative ion transitions were at m/z 422.2→105.1 and m/z 425.2→108.1, respectively. The method was calibrated with linear regression using five-point calibration curves.
Results: The correlation coefficients between the peak area ratios and glycerol concentrations were 0.9999 and higher. The within-run coefficients of variation (CV) for serum total glycerol analysis averaged 0.52% (ranged 0.3%~1.02%) and the total CV 0.73% (0.49%~1.27%). Results on certified reference materials (SRM 909b Level I and Level II, SRM 1951b Level I and Level II, SRM 909c, GBW 09146 and GBW 09147) showed an averaged bias of 0.32% (0%~0.97%).
Conclusion: Isotope dilution LC/MS/MS method for serum triglyceride has been developed. This method was been used in international laboratory comparison including RELA (IFCC) and Cholesterol Reference Method Laboratory Network(CRMLN,US. CDC). Results showed that this ID-LC/MS/MS method was well-characterized for serum glycerides with a theoretically sound approach, demonstrated good accuracy and precision, and low susceptibility to interferences qualifies as a candidate reference method. Use of this reference method as an accuracy base may reduce the apparent biases in routine methods along with the high interlaboratory imprecision.


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Poster Presentations for


Lipidomic Profiling of Colorectal Cancer Cell Lines under Hypoxia

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Poster #4c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Colorectal cancer (CRC) is the third and second most common cancer occurring in men and women respectively. During CRC development, the tumor microenvironment has shown to be a key component to sustain progress and spreading of the tumor. The tumor microenvironment is a complex and dynamic matrix in which different cell types interact with each other to sustain tumor growth. In addition, this dynamic system shows fluctuation in physicochemical conditions. Hypoxia is a well-known state during tumor development responsible for metabolic adaptation, and promotion of tumor invasion. However, the role and mechanisms by which hypoxia induces lipid re-modeling are still not understood. Nevertheless, this regulation is related to tumor and stroma phenotype key players to better understand the tumor-microenvironment.
OBJECTIVES: The primary objective of this study was to describe changes in the lipid profiling of four colorectal cancer cell lines after 24 hours of incubation under hypoxia.
METHODS: Four colorectal cancer cell (CRC) lines, HT29, HCT116, SW480, and LS174T, were seeded and grown to almost 80% confluency, subsequently the cells were incubated in a hypoxia incubator at 1% O2 for 24 hours. After incubation, lipids were extracted and quantitatively measured with a QTRAP 5500 system and SelexION Technology, using the Lipidyzer platform from SCIEX. Data were analyzed using GraphPad and Metaboanalyst, changes were noted comparing normoxia (20% O2) versus hypoxia.
RESULTS: Lipid profiling of the four cancer cell lines at basal state showed clustering according to disease stage. During hypoxia, these clusters are changed and rearranged, depending on the degree of cellular differentiation of the CRC. Using two way ANOVA analysis it was evident that a common feature shared by all cell line, triggered by hypoxia was the significant (p<0,001) downregulation of two specific lipid classes phosphatidylcholines and sphingomyelins. With respect to the lipid composition of the four investigated CRC, we found that hypoxia caused an upregulation in dihydroceramides, in all four cases. In particular, SW480 and LS174T showed an upregulation in all ceramide-related lipid classes, which could be associated with specific regulation of ceramide metabolism of these cell lines under hypoxia.
CONCLUSIONS: The lipid profile of CRC cell lines during a 24 hours hypoxia was described. It shows that hypoxia induces clear changes in lipid classes’ concentration and composition. Particularly, SW480 and LS174 cell lines showed changes in ceramide metabolism induced by hypoxia.


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LC-MS/MS Method for Screening of Intoxication and Drug Adherence of Angiotensin Converting Enzyme Inhibitors in Plasma

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Poster #13b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

BACKGROUND
Angiotensin converting enzyme inhibitors (ACEIs) are used for the treatment of cardiovascular diseases. The therapeutic effectiveness of these preventive agents is closely related to medication adherence by patients. Additionally, the increased availability of these drugs has led to the increased events of intoxication either intentionally or unintentionally. Qualitative screening of these agents using liquid chromatography-tandem mass spectrometry (LC-MS/MS) represents a reliable technique for monitoring medication adherence as well as intoxication.
OBJECTIVE
The objective was to develop a qualitative screening method for commonly prescribed angiotensin converting enzyme inhibitors in residual blood volume.
METHODS
Oasis® mix mode anion exchange (MAX) 96 well plate was used for solid phase extraction (SPE) to achieve sophisticated sample preparation. The LC-MS/MS (Shimadzu LC.10; Sciex, API 2000) in positive ion mode was performed using X-select CSH™ C18 analytical column. A gradient elution was used consisting of acetonitrile and water (both featuring 1% formic acid and 2 mM ammonium formate) as the mobile phase with a total run time of 10 minutes at 0.4mL/min. Fit-for-purpose method validation for semi-quantitative screening method was applied for following parameters: accuracy and precision, limit of detection (LOD), recovery and matrix effect.
RESULTS
The linearity ranged from 0.78-100 ng/mL covering typical plasma drug concentration levels in adults after daily dosing. The calibration curve was linear with co-efficient of correlation value (r ≥ 0.995) for all analytes except for perindopril (r=0.993). The method exhibited sensitivity with the LOD ranged from 0.41 to 0.65 ng/mL making its applicability in paediatric patients having a risk of severe side effects even with very low drug concentration due to inappropriate administration or unintentional intoxication. Inter-day accuracy and precision for low quality control level was within ±20% (80.98 to 108.71%) and (1.98 to 11.79%) respectively. At middle and high quality control level, inter-day accuracy was ±15% ranged from 90.06 to 109.64%. Inter-day precision ranged from 2.55 to 14.93% at middle and high quality control levels. Only perindopril and trandolapril slightly deviated in inter-day precision at low quality control levels (21.59 and 22.84%). The obtained recoveries were ≥ 87% and absolute matrix effect ranged from 100 to 113%. The method showed good repeatability for all analytes (1.9 to 15.8%).
CONCLUSION
The screening method was successfully developed and validated qualitatively for monitoring of medication adherence and intoxication of 10 ACEIs in 50 μL residual blood samples.
DISCLOSURE
The results presented here have already been published in BIOANALYSIS VOL. 10, NO. 23 and permission was duly obtained from the journal editor to present the contents as a poster on congress.


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Development of a Candidate Higher Order Reference Measurement Procedure for the Analysis of Metanephrines in Plasma Using Micro-Flow LC-MS/MS

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Poster #4b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Metanephrine and normetanephrine are the metabolites of adrenaline and noradrenaline, respectively. The determination of elevated levels of these compounds in plasma is used to diagnose the presence of pheochromocytoma and paraganglioma by a number of different methods, but mainly based on liquid chromatography coupled to mass spectrometry (LC-MS). A need for standardisation and harmonisation of plasma metanephrines (METs) analysis has been identified by the international pheochromocytoma and paraganglioma research support organization (PRESSOR). This is particularly challenging due to the low uncertainty and traceability required at the very low concentrations these compounds are typically measured at in plasma; normetanephrine 23-192 pg/mL and metanephrine 6-88 pg/mL(1).
Objectives: The aim is to develop a traceable, exact matched isotope dilution mass spectrometry (EM-IDMS) based higher order reference analytical method for the analysis of plasma METs.
Methods: We present the evaluation and optimisation of a micro-flow LC system as a solution to reaching the performance required for a higher order reference method. Agilent 1260 infinity micro-flow LC was coupled to an Agilent 6490 triple quadrupole mass spectrometer. The set up involved the micro-flow pump (maximum 100 µL/min), the micro-autosampler and a micro-flow column (1.0 x 150 mm, 1.8 µm) connected via a column coupler directly into the MS source. Plasma sample preparation clean-up was performed using a mixed mode cation exchange 96 well solid phase extraction plate.
Results: Very low matrix suppression effects were observed and high injection volumes were feasible up to 8 µL. Evidently, micro-flow LC method demonstrated up to a seven-fold increase in signal-to-noise ratio with a significantly improved detection limits compared to the same method using standard scale LC flow. Two independent human plasma materials were analysed using the candidate reference measurement procedure. The measurements of the frozen human plasma for normetanephrine was 137 pg/mL and for metanephrine was 31 pg/mL with expanded measurement uncertainties (k = 2) of 4-7% and 5-6% respectively for different sample units. The lyophilised human plasma material measurements of normetanephrine was 97 pg/mL and for metanephrine was 45 pg/mL with expanded measurement uncertainties (k = 2) of 5% and 6% respectively.
Conclusion: A candidate higher order reference measurement procedure has been developed for the analysis of plasma METs that achieves low measurement uncertainty and traceability at concentrations below 150 pg/mL with expanded uncertainties ranging 4-7% for normetanephrine and metanephrine. This is the first step towards the standardisation of this analytical test which would ultimately result in improved diagnosis accuracy and better patient health care. Reference: (1) Rao D, Peitzsch M et al. doi:10.1530/EJE-17-0077.


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Untargeted Data Independent Acquisition Analysis of Drugs of Abuse by LC-MS/MS, a Generic Approach for Routine Clinical Pathology Screening

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Poster #10d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction: For toxicological screening, methods not only need to be highly specific and sensitive but capable of identifying and quantifying a broad range of analytes in complex matrices. In this work a generic data independent acquisition (DIA) method was developed to detect and quantify a panel of drugs of abuse in human plasma using a high resolution accurate mass LC-MS/MS QTOF system. The method was designed as a generic data acquisition approach to extend the capability of LC-MS/MS analysis in routine clinical pathology for both targeted and untargeted data analysis.
Objectives: Develop a high resolution accurate mass LC-MS/MS QTOF system capable of generating targeted and untargeted data analysis for toxicological screening.
Methods: Human plasma (BioIVT) was prepared using a QuEChERS protocol modified for clinical applications (Dulaurent et al. 2016) and spiked with a drugs of abuse panel creating calibration curves from 5 to 200ng/mL. Samples were separated using a biphenyl column binary gradient method over 10.5 minutes and analysed by an LC-MS/MS Q-TOF. All data was acquired using external mass calibration. MS acquisition scan range was m/z 100-500. Nineteen consecutive MS/MS scans were created isolating 20 Da ion width starting from m/z 120-140 through to 480-500; measurement mass range m/z 40-500, each MS/MS scan lasting 25 msec. Collision energy scanning (0-30V) enabled detection of precursor and product ions in MS/MS scans.
Results: The DIA-MS/MS method developed on a Q-TOF platform was designed to capture precursor and product ion spectra for all ionizing analytes providing options for targeted quantitation at either the MS or MS/MS level and retrospective untargeted analysis. This approach differs from a conventional targeted approach such as high resolution MRM which is designed to be highly specific for a panel of analytes.
In this work, 41 drugs of abuse compounds were detected and quantified at the lowest calibration standard (5ng/mL) to an accuracy of 85-115% with linear and quadratic calibration curves up to 200 ng/mL for all targets using precursor DIA-MS/MS data (as each mass scan used a collision energy from 0-30V both precursor and product ion were present in the DIA-MS/MS data). As a generic method this DIA-MS/MS acquisition method requires no other modification for the analysis of other small molecule compound classes such as antidepressants, immunosuppressants, multi-panel analytes.


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Evaluating the Stability of Breath During Storage in Thermal Desorption Tubes by Mass Spectrometry

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Poster #10b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
The relationship between volatile organic compound (VOC) content in the breath and disease state is well established and so breath analysis has the potential to become a non-invasive early diagnostic tool. Direct sampling techniques such as proton transfer reaction mass spectrometry (PTR-MS) and selected ion flow tube mass spectrometry (SIFT-MS) have been used to probe differences in VOC profiles in clinical studies. Previous studies have used direct sampling techniques or breath collection in nalophan bags for VOC analysis. For large multi-centre studies the use of direct techniques or nalophan bags is inappropriate as samples will need to be stored on site, collected together and transported to the laboratory and may not be able to be analysed immediately, requiring further storage. A potential solution to this issue is to use thermal desorption (TD) tubes to store breath, transport to the laboratory and analyse at a later date. To validate this approach, a study to look at the deterioration of VOCs over time stored in thermal desorption tubes at a range of temperatures is being carried out.
Methods:
The Carbograph-Tenax TD tubes were conditioned as per manufacturer’s instructions then stored with air-tight brass caps on as blanks or loaded with a standard mixture of benzene, phenol, acetone, propanal, butanal and decanal, prepared by means of a permeation unit. The tubes were stored at a range of temperatures: -80°C, -20°C, +4°C, room temperature and +37°C. Desorption tubes were analysed at the start of the study (day zero), and then after 1, 3, 7, 14, 21 and 28 days. VOCs were analysed by a TD unit attached to a PTR-MS instrument with NO+ ionisation.
Results:
VOC concentrations were stable, although at 37° C acetone showed a slight deterioration after 28 days. This may be because it is the most volatile compound of the standard mixture and so it is the first to deteriorate.
Conclusion:
Results using the standard mixture are encouraging as there is no deterioration at room temperature after 28 days, indicating that TD tubes could potentially be stored without impacting on results. Further work includes expanding to breath to see the impact of the moisture in the matrix on storage and changing the ionisation mode to analyse different compounds.


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Simultaneous Determination of Cortisol and Cortisone in Saliva by LC-MS/MS: Method Validation

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Poster #25b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Cortisol measurement is a key-test in the diagnosis of Cushing syndrome and in other clinically relevant conditions. It can be performed in different biological samples: serum, urine and, in more recent years, saliva. In salivary measurements only free hormone is detected, samples can be collected during normal daily routine and stress-induced cortisol release is less likely to occur than after venipuncture. Although immunometric assays for salivary cortisol are employed, but suffer from non-specificity due to cross reactivity with steroid metabolites, synthetic corticosteroids or drugs and lack of standardization between labs.
OBJECTIVE: We developed and validated an analytical method for routine measurement of cortisol and cortisone in salivary samples.
METHODS: Saliva can be obtained by standard procedures using available devices (Salivette). 200 µL were added to an equal volume of dilution solution (containing cortisol-D4 as internal standard) and 1 ml of extraction solution. After extensive vortexing and centrifugation, 800 µL of the upper phase are collected, dried under nitrogen and resuspended with 30 µL of the reconstitution solution and 30 µL of the dilution solution. After vortexing and resuspension, 60 µL were transferred in a new vial placed in the LC-MS/MS autosampler. Samples were then analyzed using an AB SCIEX Triple Quad™ 6500 LC-MS/MS system (column: Hypersil Gold, ID 2.1x50 mm, 1.9 µm; flow: gradient; T 30°C; inj vol: 10 µL; MRM: cortisol: 363.1>121.1, 363.1>105.1; cortisone 361.1>121.1, 361.1>105.1; cortisol-D4: 367.1>121.1, 367.1>97.1; ESI+).
Within-, between-run and within-lab repeatability were calculated by ANOVA.
RESULTS: The validated method displayed as LLOD 5,7 pg/mL (cortisol) and 2.7 pg/mL (cortisone), as LLOQ 19.1 pg/mL (cortisol) and 9.0 pg/mL (cortisone), linearity 19.1-50000 pg/mL (cortisol) and 9.0-160000 pg/mL (cortisone), recovery 96-103% (cortisol) and 89-110% (cortisone); within-run, between-run and total repeatability was respectively 3.7 %, 4.9 % and 6.1 % for cortisol (at a concentration of 15 ng/ml) and 2.5 %, 5.3 % and 5.9 % for cortisone (at a concentration of 38 ng/ml). Samples can be stored up to three months at 4°C or up to one year at -20°C.
CONCLUSION: A LC-MS/MS method was developed and validated for the routine measurement of cortisol and cortisone in salivary samples. This method will allow to reduce laboratory errors due to both sample collection and unspecific measures, may assist the clinicians in the diagnosis of endocrinological diseases and will avoid unnecessary hospitalization (for late night collection) and invasive procedures.


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Confident Quantitation of 25-Hydroxyvitamin D2 and D3 in Human Plasma for Clinical Research by LC-MSMS

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Poster #14e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: Vitamin D is hydrolized to its prohormone 25-hydroxyvitamin D in the liver, and being a predominant metabolite, circulating 25-hydroxyvitamin D serves as the preferred analyte that is monitored to determine nutritional status of Vitamin D.
Owing to its increased selectivity and specificity while addressing sensitivity, robustness, and reliability requirements, liquid chromatography (LC) coupled to mass spectrometry (MS) has become the platform of choice for analysis and quantitation of Vitamin D in biological matrices. An analytical method for quantitation of 25 hydroxyvitamin D2 and D3 in human plasma with simple sample preparation is reported for clinical research.

Objectives: Implementation of a high throughput analytical method for quantification of 25-hydroxyvitamin D2 and D3 in human plasma using a Thermo Scientific™ Transcend™ LX-2 system and a Thermo Scientific™ TSQ Quantis™ triple-stage quadrupole mass spectrometer.

Methods: Samples were prepared by precipitating 50 µL of plasma with 150 µL of Acetonitrile containing the internal standards. Calibrators obtained from RECIPE® Chemicals + Instruments GmbH (Munich, Germany), ranged from 9.84 to 81 ng/mL, and 9.04 to 78.9 ng/mL for 25-hydroxyvitamin D2 and D3 respectively. Chromatography was performed on a Transcend LX-2 system, connected to a TSQ Quantis triple-stage quadrupole mass spectrometer. LC separation was achieved in a Thermo Scientific™ Hypersil GOLD™ (50 x 2.1 x 1.9 µm) column. Mobile phases consisted of Water and Methanol, both containing 10mM Ammonium Formate and 0.1% Formic Acid. Total runtime was 3.5 minutes. Analytes and Internal Standards were detected using SRM mode with Atmospheric Pressure Chemical Ionization in positive mode.

Results: Regression coefficients for both analytes were above 0.999. The percentage bias between nominal and back-calculated concentration was within ±10% for all the calibrators in all the runs.
The data demonstrated outstanding accuracy of the method with the percentage bias between nominal and average back-calculated concentration for the used control samples ranging between -2.5% and 2.6%. The %CV for intra-assay precision was less than 3.6% for all the analytes. The maximum %CV observed for inter-assay precision, including all the analytes, was 4.1%.

Conclusion: A robust, reproducible, and reliable assay exhibiting best-in-class sensitivity was developed using liquid chromatography-tandem mass spectrometry for clinical research for quantification of 25-hydroxyvitamin D2 and D3 in human plasma. The method was analytically validated with a multichannel LC system connected to a mass spectrometer. Sample preparation consisted of simple and robust protein precipitation of the calibrators and controls were obtained from RECIPE.The data obtained with the described method successfully met sensitivity, reliability, accuracy, and precision expectations typically demanded by clinical research laboratories.


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SCOUT Rtbeads, A Useful Tool for LC-MS Retention Time Control: A Relevant Application for Multiplex LC SRM Biomarker Quantitation

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Poster #27e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction
Targeted proteomics analysis based on Multiple Reaction Monitoring approach (MRM) allows high specificity, sensitivity and reproducibility in complex biological matrices, in regards to its intrinsic properties. This latter is thus considered as the golden approach for quantification purposes and a growing interest appeared, particularly in biomarker discovery field and clinical analysis. However, this analysis mode is currently limited by its multiplexing capabilities. According to scheduled MRM mode (sMRM), this limitation was over-passed, but sMRM assay development remains complicated and time consuming. Also, Retention Times (RTs) must be known and reproducible. This constraint is poorly compatible with routinely clinical analysis in which RTs shifts occur due to both instrumental system variations and samples differences induced by biological heterogeneity. A new approach, the so-called SCOUT-MRM approach was developed, which keeps sMRM multiplexing capabilities without RTs constraints.

Objectives
The following poster presents “peptide selector”, a new tool to automatically implement a SCOUT-MRM method. This tool, coupled to SCOUT-MRM-BEADS kit (based on READYBEADSTM technology) was developed to automatically rank peptides of interest in the appropriate SCOUT groups. SCOUT groups peptides monitoring is then triggered by detection of reporter peptides (SCOUT-MRM-BEADS kit), independently of RT. This approach opens new opportunities to develop highly multiplexed MRM assay, individually for each sample, with an easy straightforward fashion. Also, it ensures high reproducibility between samples, since all peptides are detected even with high RTs shifts between them. For clinical analyses, data completeness and robustness (detect and identify all peptides in each analysis) are a requirement, and this approach brings a serious analytical answer.

Method
To illustrate and highlight the interest of “peptide selector” software, coupled to SCOUT-MRM-BEADS kit for multiplex analysis, 58 peptides from 40 proteins were monitored in serum samples, either with classical sMRM method, or with automatically-generated SCOUT-MRM method.
Results
18 peptides were detected after screening a plasma sample with conventional sMRM method, while SCOUT-MRM automatically-generated method allowed detecting the 58 peptides.


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Mass Spectrometry Techniques for Volatile Organic Compound Measurement in Cell and Organoid Media

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Poster #12b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction. Measurement of volatile organic compounds (VOCs) in breath is increasing in importance as a non-invasive diagnostic tool, especially for complex pathologies such as cancer [1]. Many methodological and clinical studies have been carried out to develop sophisticated new mass spectrometry methods and pinpoint differences in VOC levels between patients and controls. However, the origin of VOCs and their imbalance in certain diseases remain poorly understood. In a recent study from our group, cancer tissue headspace (HS) has been analysed ex-vivo to evaluate the in-loco production of VOCs [2]. In this study, we developed two different techniques of sample collection and analysis for VOCs in the HS of cells and organoids to create a new tool that will help clarify the role and production of VOCs in-vitro.
Methods. VOCs were measured in the HS of human gastric organoid culture and HCT116 cells using two different methods: (i) direct HS measurement via a heated inlet attached to a proton transfer reaction time-of-flight mass spectrometry (PTR-ToF-MS) (ii) indirect measurement of VOC extracted from media using HiSORB probes with PTR-ToF-MS. The two methods were compared in terms of recovery, linearity of the response and precision.
Results and Conclusion. We created a new direct and indirect approach for VOC measurement in organoids and cell lines that offer a good recovery and linear response. The method can be widely used to enhance the future understanding of VOC origin and imbalance, therefore offering new strategies for early diagnosis and monitoring of complex pathologies.



1. Hanna, G.B., et al., Accuracy and Methodologic Challenges of Volatile Organic Compound-Based Exhaled Breath Tests for Cancer Diagnosis: A Systematic Review and Meta-analysis. JAMA Oncol, 2018: p. e182815.
2. Adam, M.E., et al., Mass-Spectrometry Analysis of Mixed-Breath, Isolated-Bronchial-Breath, and Gastric-Endoluminal-Air Volatile Fatty Acids in Esophagogastric Cancer. Anal Chem, 2019. 91(5): p. 3740-3746.


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LC-MS/MS Analysis of Plasma Epinephrine and Norepinephrine

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Poster #25e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Background:
The catecholamines, epinephrine (E) and norepinephrine (NE) are important both as neurotransmitters and hormones, affecting body functions such as blood pressure, heart rate, lipolysis, glycogenolysis, fatty acid mobilization and body temperature regulation. Measurement of E and NE in plasma is therefore of great interest in medical research. However, because of the low concentrations of E and NE in plasma (reference levels of 0.03 - 0.98 nmol/L for E and 0.63 – 4.5 for NE), and the instability of the catechol group, this is not an easy task. Furthermore, E and NE are very small and polar molecules, causing additional challenges to LC-MS/MS method development, as they are poorly retained on reverse-phase C18 columns, and elute in solvent with very low organic content (maximum 5%), which leads to poor ionization in the mass spectrometer.

Methods:
Plasma E and NE was extracted using solid phase extraction on Waters Sep-Pak Alumina B, 100 mg 96 well extraction plates. After elution the samples were diluted with the ion-pairing reagent, 1-Heptane Sulfonic Acid (HSA) and analyzed on a Waters Acquity UPLC with Xevo TQ-S tandem mass spectrometer operated in electrospray positive mode (ES+). The chromatographic separation was achieved with a Phenomenex Kinetex Biphenyl (100 x 2.1 mm, 2.6 µm) column and gradient elution with mobile phases consisting of 0.1% formic acid in water (mobile phase A) and methanol (mobile phase B).

Results:
The method is calibrated using seven in-house prepared calibrators. The calibration curve is linear up to 10 nmol/L. Intermediate precision for control samples is <7% and the limit of quantification (LOQ) is 0.20 and 0.02 nmol/L for NE and E, respectively.

Conclusions:
We have developed an LC-MS/MS method for simultaneous measurement of E and NE in plasma. The assay has good performance characteristics and is sensitive enough to measure plasma levels in the entire normal range. Furthermore, this method has been used in research projects to demonstrate changes in plasma E and NE levels in hypoglycemic diabetics.


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A High-throughput LC-MS/MS Method for Vitamin A and Vitamin E

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Poster #14h View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Background: Assessment of vitamin status is of clinical as well as nutritional importance. We wanted to develop a robust high-throughput LCMS-method for routine analysis and quantification of serum all-trans-retinol (Vitamin A) and α-tocopherol (Vitamin E). The method was based on comprehensive optimization of an assay currently in use at the Hormone Laboratory.

Method: Automated procedure for sample preparation was performed using liquid-liquid extraction on a Tecan Evo Freedom 150. In brief: serum was added to ethanol with C13-labelled analyte internal standards (IS), then hexan was added for extraction and further transferred to tubes for evaporation and reconstitution in methanol where 0.2 g/L Butylated Hydroxytoluene (BHT) was added for stabilization of the analytes. Chromatographic separation of Vitamin A and Vitamin E was achieved on a Nexera X2 UPLC-system equipped with an Agilent ZORBAX Eclipse Plus C18 column. Gradient: water:methanol containing 0.1 % FA from 71-91 % methanol over 9.5 min, sample injection volume 1 µl. Analysis by MS/MS was performed on a Sciex TQ API4500 in positive ESI mode. Standard reference material (SRM), and quality controls (QC) were used to validate accuracy and precision of the method.

Results: The method demands only 25 µl patient serum. Sample preparation with LLE, evaporation and reconstitution is completed within 2 hours. Measurement range for routine use is defined by the upper and lower calibrators; 0.16-12.4 µmol/L for vitamin A and 1.86-125 µmol/L for Vitamin E. Linearity was tested for Vitamin A also beyond the measurement range and found between 0,05-60 µmol/L. Using in-house made QC’s at three levels (pooled patient sera) and ClinChek1-3 (Chromsystems) total presicion was found to be below 10.2 % for Vitamin A and 9.6 % for Vitamin E at all levels. The method was robust towards matrix effects, and is tracable to the NIST SRM 968f. Reference ranges were adapted from the Mayo Clinic and verified with 20 healthy fasting volunteers (employees).

Conclusions: We have optimized and further developed a robust LCMS/MS-method for measurement of Vitamin A and Vitamin E. The method is compatible with the work-flow and capacity needed in a medical laboratory.


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A Sensitive Microflow LC-MS/MS Method for the Analysis of Corticosteroids in Human Plasma

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Poster #24d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction:
Corticosteroids includes 6 steroid hormones of Cortisol, Corticosterone, 11-Deoxycorticosterone (11-DOC), 11-Deoxycortisol(11-DOCL), Testosterone and Aldosterone, which are involved in a wide range of physiological processes.
Due to low concentration and strong interference of Aldosterone, the reported sample-preparation method required a large volume of plasma (500uL) enrichment to achieve the LLOQ 10pg/mL. However, it’s difficult to achieve enough volume for every plasma sample. To obtain the required sensitivity needed for this assay with the preparation of only 50uL plasma, microflow LC/MS was utilized. Using this technique, the sensitivity of 6 compounds were enabled to improve 5-15X than normal UPLC flow rate. This enhanced level of sensitivity allows for the accurate determination of 6 steroid hormones from a starting volume of only 50uL plasma.
Methods:
Standards, QC’s and blanks were prepared by spiking in a known concentration of 6 steroid hormones and Internal standard (Corticosterone-d8) into 50 µL of human plasma. After samples were extracted by liquid/liquid extraction (LLE) method, the supernatant was evaporated to dryness and the residue was reconstituted in 100 µL of 20% methanol.
Chromatographic separation was performed on a Eksigent HaloTM C18 (0.5×50mm, 2.7um, 90A). Mobile phase A consisted of 2mM ammonium acetate and Mobile phase B consisted of 100% methanol. Mass spectrometric detection was conducted on a QTRAP®5500 mass spectrometer, operating with the polarity switch of positive and negative ion mode.
Preliminary results:
A method was developed for the quantification of 6 steroid hormones in human plasma using liquid/liquid extraction with only 50µL plasma, followed by reversed phase microflow chromatography and tandem quadrupole mass spectrometry. The separation was performed by applying a gradient from 20% to 90% B over 11 minutes at a flow rate of 5 μL/min. During method development, it was determined that 5 μL/min of micro flow rate gave 5-15X greater sensitivity over the typical standard 400 μL/min flow rate.
Using this approach, a calibration curve was prepared by spiking known concentrations of 6 steroid hormones into human plasma. The calibration range was linear from 0.01 to 10 ng/mL for Aldosterone in negative mode with an r value of 0.9980. At the same time, the calibration curve of other 5 steroid hormones in positive mode are linear from 0.1-100ng/mL with r value from 0.9912 to 0.9988. In order to determine the precision of this method, 3 replicate QC samples were prepared at 3 concentration levels and extracted. The precision of 6 steroid hormones in QC samples for each concentration was determined to be <15%.


Novel Aspect: Utilization of microflow LC/MS/MS to achieve Corticosteroid quantitation at low pg/mL levels in significantly reduced volume of plasma.


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Influence of Saw Palmetto and Pygeum Africana Extracts on the Urinary Concentration of Anabolic Androgenic Steroids

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Poster #1c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
The detection of doping by “pseudo-endogenous steroid” (endogenous steroid when administered exogenously) is based on the longitudinal monitoring of six steroidal urinary markers and their relative ratios by the application of a Bayesian adaptive model that is able to predict the maximum individual variability for each marker based on the previous data to outline atypical results. Although the introduction of the longitudinal steroid profile clearly improved the detection of the pseudo-endogenous steroid doping, it does not allow to gather any information on the occurence of atypical profiles due to the presence of endogenous or exogenous confounding factors that could influence the urinary excretion of the described markers.
Objective
The aim of the present work is to evaluate the influence of the administration of a daily dose of nutritional supplements (Saw palmetto and Pygeum africana herbal extracts) containing β-sitosterol, on the urinary concentrations of a series of target steroids non limited to those included in the steroidal module of the Athlete Biological Passport (ABP).
Methods
After enzymatic hydrolysis with β-glucuronidase and liquid-liquid extraction at pH 9 with tert-butylmethyl ether, all urinary samples, collected from three caucasican volunteers before (six samples/day for five consecutive days) and during (six samples/day for five consecutive days) the administration of the Saw palmetto and Pygeum africana herbal supplements, were analyzed by gas-chromatography tandem mass spectrometry (GC-MS/MS) according to the validated and routinely applied analytical procedure performed in our laboratory to determine the urinary steroid profile of each athlete.
Results
In this work we have highlighted the effects of the intake of β-sitosterol contained in herbal supplement on the parameters considered in the evaluation of the pseudo-endogenous steroid doping. Our results have shown that oral administration for five consecutive days provokes an alteration of the levels of some target steroids and of the corresponding concentration ratios, most likely due to effects on cholesterol and prostaglandin metabolism. These effects could interfere with the correct longitudinal evaluation of the steroid profile, causing misinterpretations in the data collected in the framework of the ABP.
Conclusions
The influence of Saw palmetto and Pygeum africana herbal supplement containing β-sitosterol on the analytical strategy currently adopted for the detection of pseudo-endogenous steroid doping should be carefully taken into account, also given the wide diffusion of “over-the-counter” products. The large intake of this kind of preparations could be a source of interference in the correct longitudinal evaluation of the steroid profile, as described in the framework of the ABP.


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Simple and Rapid Tandem Mass Spectrometry Method for the Analysis of Methylmalonic Acid in Urine

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Poster #9a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: Vitamin B12 deficiency can lead to potentially irreversible neurological symptoms such as memory deficits and gait ataxia. Up to 40% of older adults show metabolic abnormalities due to vitamin B12 deficiency. However, most adults have normal levels of serum B12 so that this condition often remains under-recognized. Metabolic B12 deficiency causes an elevation of serum methylmalonic acid (MMA), an expensive test rarely available in clinical settings. Urine MMA also increases in cases of B12 deficiency, but it is unclear whether it correlates with serum MMA and thus be reliable for diagnostic purposes. Also, various inborn errors of metabolism lead to increased MMA levels in urine and plasma.

Objectives: The objectives of this research project were: 1) To develop and validate a multiplex UPLC-MS/MS method for the analysis of MMA and creatinine in urine without derivatization; 2) To determine MMA/creatinine levels in urine from a group of 35 older adults (>70 yrs) at different stages of B12 deficiency; 3) To compare the urine results obtained with this method with a validated GC/MS method necessitating derivatization; 4) To perform correlation studies between urine and serum MMA levels from samples collected at the same time from the same patients; 5) To analyze the levels of MMA/creatinine in urine samples collected on filter paper from newborns having B12 deficiency.

Methods: Briefly, 30 µL of urine were mixed with 60 µL of water containing MMA-D3 and creatinine-D3 internal standards. A 2-minute reverse phase chromatographic method was developed/validated, allowing the separation of MMA from succinic acid, a major isomeric interference. The Acquity I-Class UPLC system (Waters Corp.) was used. The absolute quantitation of MMA and creatinine was achieved by tandem mass spectrometry (Xevo TQ-S Micro, Waters) using the multiple reaction monitoring mode. Calibration curves with ranges up to 500 µM for MMA and 30 µM for creatinine were prepared. For newborn urine filter paper specimens, a 5 cm disk was extracted with 3 mL of NH4OH 0.01 M and analyzed in a similar manner.

Results: The validation of the method showed intra- and interday variations < 15%. Our results show that UPLC-MS/MS urine MMA/creatinine levels from 35 older adults were similar to those obtained by the GC-MS MMA method. Moreover, the correlations between MMA urine results obtained by UPLC-MS/MS with the plasma GC-MS results from the same patients were significant (Spearman r = 0.59).

Conclusion: A rapid and efficient UPLC-MS/MS method for the analysis of urine MMA and creatinine was developed and validated, requiring only a dilution of the specimen with the internal standards in a 2-min chromatographic run. This preliminary study suggests that MMA/creatinine urinary levels are equivalent to MMA plasma levels to evaluate B12 deficiency in older adults. Another method advantage is that urine specimen collection is less invasive than blood collection.


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Comprehensive Clinical Acylcarnitines by LC-MS/MS

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Poster #20a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Acylcarnitine profiling is routinely performed in order to quantitatively screen for disorders related to β-oxidation and / or organic acid metabolism. Today many laboratories still perform acylcarnitine profiling using LC-MS/MS based methodology that has remained almost unchanged for around 2 decades. This “classical” approach normally involves a direct infusion (no chromatographic separation) into the MS system following a butylation based sample derivatisation. Although this approach is still widely used today, improvement in LC-MS technology observed over the last 15 years such as UHPLC and higher sensitivity MS systems means that a non-derivatisation approach that can be more informative with a relatively rapid LC separation is feasible.

OBJECTIVES: The primary objective of the work was to replace existing methodologies within our hospital in order to enhance efficiency whilst keeping or improving upon analytical quality.
METHODS: The new method described consists of a simple protein precipitation (isotopic dilution) and relatively large sample dilution followed by a HILIC separation (UHPLC) and subsequently MS detection in the MRM mode. This approach allows the separation and quantification of 42 individual acylcarnitines. Comparisons were made with established, routine methods within our laboratory: the “classical” acylcarnitine profiling approach and a method for the quantification of free and total carnitine also by LC-MS/MS.

RESULTS: Free carnitine (C0) and total carnitine (the sum of all free and acylcarnitines in plasma / serum) compared well with the established routine LC-MS/MS targeted method for C0 (Passing-Bablok: Slope (95% CI): 1.04 (0.99-1.07), n = 57) and total carnitine (Passing-Bablok: Slope (95% CI): 0.96 (0.91-1.06), n = 57). For the evaluation / comparison between methodologies for the acylcarnitine quantitative profiling, 84 patient samples were compared, 23 of which were confirmed cases of either β-oxidation or organic acid metabolic disorders. The new method compared well, successfully identifying all the 23 confirmed cases.

CONCLUSION: The new method described will replace two existing routine methods within our hospital, therefore greatly improving upon laboratory efficiency and significantly increasing the number of samples that can be prepared, run and processed for routine analyses. We estimate that this development saves around 1-1 ½ days per week of both instrumental and technical labour time.


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Prognostic Potential of Combined Omics Analysis for Diagnostics of Azoospermia

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Poster #17d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Background: The male factor contributes to more than 50% of couples with conceive failure. Seminal plasma seems to be a promising noninvasive informative source for male infertility biomarkers. The possibility combined omics analysis of seminal plasma composition in defining the residual spermatogenesis during azoospermia was tested by the supervised OPLS-DA. Quantitative parameters of the model obtained turned out to be satisfactory to differentiate patients with residual spermatogenesis.
Methods: Seminal plasma samples were obtained from 36 male patients from 21 to 45 years (33.3 ± 3.9 years), examined and treated for azoospermia. Clinical examination includes clinical and anamnestic data collection. A testicular sperm micro extraction method was used for the residual spermatogenes.
For proteomic analysis the in-solution samples preparation method was used followed by trypsin digestion. Tryptic peptide mixtures were separated on a nano-HPLC Agilent 1100 system (Agilent Technologies) combined with 7 T LTQ-FT Ultra (Thermo Electron, Bremen, Germany) using a nanospray ion source. For label-free semi-quantitative analysis MS files were processed with MaxQuant software (version 1.6.2) against SwissProt database.
Lipids were extracted from supernatant by modified Folch method. LC-MS/MS analysis was performed via liquid chromatography Dionex Ultima 3000 (Thermo Fisher Scientific) combined with a hybrid time-of-flight mass spectrometer Maxis Impact (Bruker Daltonics) operating in the positive-ion ESI mode and negative-ion ESI mode.
Results: To assess the changes in seminal plasma proteome composition during azoospermia Welch’s t-test (p-value p<0.01) was performed and resulted in 18 significantly changed proteins. Previously, these proteins were shown to be involved in spermatogenesis. Thus, the most altered processes in the presence/absence of residual spermatogenesis in the ovaries (testicles) are immune system process (11 proteins), wound response (8) and in homeostatic processes (5).To assess the changes in seminal plasma lipids composition during azoospermia Manna-Whitney test (p-value<0.05) was performed and resulted in 69 significantly changed lipids. Analysis of lipid’s level shows that in azoospermic fluid levels of lysophosphatidylcholines and sphingomyelins are lower and levels of phosphatidylcholines, phosphatidylethanolamines and phosphatidylserines are higher.
Novel aspect: The possibility analysis in samples differentiation was tested by the supervised OPLS-DA. The score plot demonstrated good clustering of dots corresponding to distinct group of patients with azoospermia (with and without residual spermatogenesis).


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Fast and Efficient Method for Detection and Quantification of Catecholamines in Human Plasma by LC-MS/MS - Troubleshooting

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Poster #24b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be presented and discussed on Wednesday at 12:45 for 15 minutes in De Anza 2 (right outside Exhibit Hall doors across from Ionpath in Booth 36).

Introduction:
In clinical chemistry laboratories, the measurement of catecholamines in human plasma, in particular norepinephrine (NE), epinephrine (E), and dopamine (DP), is aimed to the diagnosis of neuroendocrine tumors, such as pheochromocytoma and neuroblastoma.
Many research and routine laboratories analyze this panel using extraction on alumina and electrochemical detection (HPLC-ECD). An isotope dilution method based on solid phase extraction (SPE) and reverse phase (RP) LC-MS/MS is under development. Catecholamines represent a challenge for RP LC-MS/MS for many reasons: first of all their polarity and their poor retention on RP classical C18 columns, as well as inadequate separation of normetanephrine and epinephrine which are isobaric compounds and might both be present in real samples. Also, their low level in plasma (low ng/L) is difficult to attain because of low recoveries and ion suppression from sample preparation.
Methods:
Our LC-MS/MS system was a Nexera X2 UPLC from Shimadzu (Shimadzu Corporation, Kyoto, Japan) coupled to a QT5500 triple quadrupole mass spectrometer by Sciex (AB Sciex, CA, USA) fitted with an IonDrive™Turbo V.
Results:
- Retention of catecholamines on RP chromatographic columns:
Catecholamines are polar compounds. In order to promote interactions with stationary phase and have chromatographic resolution, very polar columns have been tested: Phenomenex Luna Omega polar C18 (1.6 µm, 100 × 2.1 mm) and Kinetex PFP column (100 Å, 1.7 µm, 2.1 mm × 100 mm). Eventually, PFP column was selected as general noise level was lower. Mobile phases were water and methanol, both 0.2% formic acid. Still to facilitate interactions with polar stationary phase, solvent gradient started at 0% organic phase, as even few µL of organic solvent lead to total co-elution. Post-run equilibration time was calculated to eliminate all traces of organic solvent from the column and keep the same resolution in consecutive runs.
- Sensitivity at ppt level:
High sensitivity was reached when using mobile phases with 0.2% formic acid instead of more common 0.1%.
– Sample preparation, SPE:
SPE with weak cation exchange resin was used. Different procedures and 96-well plates were tested. Very high ion suppression was remarked in some instances: elution with acidified organic solvent (MeOH 1% or 5% formic acid) resulted in low recoveries and significant ions suppression, also related to evaporation and solvent exchange. Eventually elution with water:iso-propanol 85:15, 0.1% formic acid allowed cleaned extracts and good recoveries, in the range of 60-120%, with no matrix effect. In this case, no solvent exchange was needed. Injection volume had to be 10µL max as the iso-propanol in the injection solvent caused loss of resolution.
Conclusion:
A method for the detection and quantification of catecholamines in human plasma is under development and still needs to be tested for selectivity and sensitivity on real samples.


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Simultaneous Quantitation of Controlled-Substances/Pain-Management Drugs in Oral Fluids via Coated Blade Spray-Tandem Mass Spectrometry

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Poster #21a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Coated Blade Spray (CBS) is a technology that combines sample preparation and direct coupling to mass spectrometry (MS) on a single device. CBS is a coated stainless steel sheet with the shape of a small sword with an ultra-thin SPME coating that permits rapid enrichment of small molecules present in complex samples via free-concentration. As a substrate spray technology, it can generate instrumental signal on a mass spectrometer by supplying a small amount of organic solvent to the coated area of the device and then applying a strong electrical field to the non-coated area of the device, which in turn generates gaseous ions from a the tip of the CBS via electrospray ionization (ESI).
OBJECTIVES: In this work, we explore for the first time its application towards the determination of several controlled-substances/pain-management drugs in oral fluids. As a proof-of-concept, we investigate its applicability to large (>100 µL) and small (<20 µL) sample volumes of OF.
METHODS: Hydrophobic-Lipophilic Balance (HLB) particles were selected as the extraction phase and CBS devices. The CBS analytical protocol comprised three steps: 1.) Analyte-enrichment, by extracting from a 96-well plate containing the samples. 2.) Coating-cleaning, which involved immersing the CBS device in water for fast removal of any loosely attached; and 3.) Instrumental analysis, which is performed by applying 5 µL of a methanol/water onto the coated area. After 10 s, 4 kV were applied to the non-coated area of blade for 5 s, inducing electrospray ionization..
RESULTS: The optimized CBS-MS/MS method enabled outstanding limits of quantitation (≤ 5 ng/mL) for most of the target molecules (e.g. cocaine, fentanyl, EDDP, fluoxetine) in oral fluids. A comparison between the CBS-MS/MS method and the confirmatory test (via LC-MS/MS) showed good agreement (R2 ≥ 0.95) between both approaches for all analytes. As a proof-of-concept, the method was also examined for the analysis of droplets of oral fluid.
CONCLUSIONS: The optimized CBS-MS/MS method demonstrated outstanding precision (RSD<10 %), LOQs equal to or below 5 ng/mL and excellent linearity (R2 > 0.99) for each of the selected compounds over the range evaluated. Furthermore, it was proven that the methodology could also be applied to small sample volumes such as oral fluid droplets. Our work is currently focused on providing a fully automated platform that can aid in decreasing the total analysis time for 96 samples to under 10 min.


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Targeted Metabolomics Reveals an Influence of the FTO Gene on the Kynurenine Pathway

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Poster #1d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Genome wide association studies have identified the FTO gene as the first susceptibility gene of obesity. Previous studies have suggested a role of FTO in nucleic acid repair or modification, but how this leads to an alteration in energy homeostasis is unclear. In the present study, we utilized targeted metabolomics in an attempt to further elucidate mechanisms underlying the action of the FTO gene.

METHODS: This study was part of a health survey of employees of the Electricity Generating Authority of Thailand (n = 79 , 9 female and 70 male). Targeted metabolomics analysis was performed using the AbsoluteIDQ™ p180 kit combined with flow injection analysis and liquid chromatography tandem mass spectrometry. Genotyping of the FTO rs9939609 was performed using real-time PCR (TaqMan® MGB probes).
RESULTS: Using OPLS-DA, there was no apparent clustering of the metabolites in relation to the FTO genotype. Nevertheless, using variable importance on projection to identify metabolites with higher influence on potential clustering, it was found that tryptophan was among the metabolites within the 10 highest VIP scores. We therefore further examined the influence of the FTO gene on the major pathway of tryptophan catabolism, the kynurenine pathway. Pearson’s correlation analysis showed that kynurenine and tryptophan was positively correlated only in subjects with the rs9939609 G allele (n = 32, r = 0.56, p < 0.001) and the correlation coefficients were significantly higher in subjects having the G allele compared to those subjects without the G allele (P < 0.05). Moreover, kynurenine/trytophan ratio, a biomarker of the degree of tryptophan to kynurenine conversion, was significantly associated with the presence of the G allele independent of body mass index and gender.

CONCLUSION: FTO gene influences the conversion of tryptophan to kynurenine. Alternation in the kynurenine pathway may be one of the mechanism underlying the action of FTO in the pathogenesis of obesity and its related effects.


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Quantitative Determination of Human IgA Subclasses and their Fc-Glycosylation Patterns in Human Plasma by Using Peptide Analogue Internal Standard and UHPLC-MS/MS

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Poster #13a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Rationale:
Glycosylation on the Fab and Fc regions of immunoglobulins is important for our immune function. In this study, we developed and validated a method for quantification of immunoglobulin A by using affinity purification and UHPLC-MS/MS analysis. Twenty-seven of IgA related Fc N-glcopeptides were also detected simultaneously.
Methods:
Peptide M was used to purify IgA, and a peptide analog was added as an internal standard. After on-bead digestion, samples were analyzed by UHPLC-MS/MS instrument. After validation, the method was applied to plasma samples from 24 patients and 6 healthy controls. And the results were compared to ELISA assay.
Results:
Correlation coefficient was higher than 0.999 in IgA1 and IgA2 calibration curves and over than 0.979 in regression curves of glycopeptides. Intra-day and inter-day precisions for IgA1 and IgA2 were <1.6% and <5.1% RSD. Intra-day and inter-day accuracies were ranged from 102.6-114.9% and 103.5-113.5% for IgA1 and IgA2. Recoveries for IgA1 and IgA2 in long term and short term stability were ranged from 96.0-109.4%. Recoveries after freeze and thaw for three cycles were ranged from 93.2-113.2% for IgA1 and IgA2. The Pearson’s correlation is 0.84 for the quantification results of 30 clinical samples by using ELISA and the developed UHPLC-MS/MS method.
Conclusions:
Purification of IgA1 and IgA2 was developed by using peptide M purification. An efficient on-bead digestion process was used before UHPLC-MS/MS analysis. The validated method was successfully applied to clinical samples which showed high correlation to the total IgA quantification results from ELISA. This method has the potential for investigating IgA profiles from human plasma.


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Fully Automated LC-MS/MS Analysis of Anticoagulants Using a Novel Reagent Kit

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Poster #11g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
Novel oral anticoagulants (NOACs) are, as an alternative therapy to vitamin K antagonists, used frequently to treat and prevent thromboembolism. Their precise quantitation is necessary to identify the presence/absence of an anticoagulant effect or to determine the concentration of drug that may be helpful for patient management.
Such analysis is mainly done by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). To streamline the workflow, we have developed a complete reagent kit including stable isotope labeled standards for better precision and accuracy. Furthermore, we demonstrate here the use of a fully automated sample preparation system (CLAM-2000) coupled online with LC-MS/MS.

Methods
To demonstrate that this multi-analyte approach, with a fully automated system LC-MS/MS, can be used as a walk-away unit, we have used a novel kit for anticoagulants analysis called DOSINACOTM (Alsachim SAS). The kit includes 9 analytes (Acenocoumarol, Apixaban, Argatroban, Betrixaban, Dabigatran, Edoxaban, Fluindione, Rivaroxaban and Warfarin) and their corresponding Stable Isotope Labeled Standards. CLAM-2000 (Shimadzu, Japan) was programmed to perform protein precipitation followed by filtration and sample collection. The sample is transported from CLAM-2000 to HPLC without human intervention for LC-MS/MS analysis in 5 min.

Results
A panel analysis of 9 Anticoagulants using an automated sample preparation system, seamlessly integrated on-line with LC-MS/MS, and combined with a ready to use reagent kit, demonstrates the capability to use a standardized platform for therapeutic drug monitoring even for non-expert users of Mass Spectrometry. We carried out concurrent analysis over a range of concentrations in 10 μg /L to 500 μg /L for the Novel Oral Anticoagulants. The calibration curves that were generated had linear regression values of r2 >0.99 for each curve. The classical LC-MS method limitations are thus dramatically decreased and it is eliminating potential errors traditionally associated with manual sample handling.

Conclusions & Discussion
The novel system workflow results in easier and safer operation for users without Chromatography and Mass Spectrometry experience, thus reducing risk of exposure and improving management of patients.


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Simple and High-throughput LC-MS/MS Method for Simultaneous Measurement of Five Smoking-related Metabolites in Urine

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Poster #5d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction: The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for simultaneous measurement of multiple nicotine metabolites can provide accurate information on smoking status and smoke exposure. However, current SPE or LLE for sample preparation is time consuming and labor intensive. Therefore, we focused on developing a simple and high-throughput method for measuring five smoking-related metabolites (nicotine, cotinine, 3-OH cotinine, nornicotine and anabasine) in population-based urine samples.

Methods: Each 30 µl of urine sample was deproteinized with 90 µL of acetonitrile and then further diluted by 120 µl of distilled water. Chromatographic separation used a Kinetex EVO C18 column (2.1mm×150mm, 5 µm; Phenomenex, CA, USA) and acetonitrile/30 mM ammonium bicarbonate (9/91, v/v) as mobile phase, at a flow rate of 0.40 mL/min. LC-MS/MS analysis was performed by a XEVO TQ-S tandem quadrupole MS equipped with an Acquity UPLC system (Waters, MA, USA). The transitions of MRM were m/z 163.2→ 84.2 for nicotine, m/z 177.2→ 98.1 for cotinine, m/z 193.2→ 86.2 for 3-OH cotinine, m/z 149.1→ 130.2 for nornicotine, m/z 163.2→ 134.2 for anabasine, m/z 167.3→ 134.2 for nicotine-d4, m/z 180.2→ 101.1 for cotinine-d3, m/z 196.2→ 134.2 for 3-OH cotinine-d3, m/z 153.2→ 134.2 for nornicotine-d4, and m/z 167.3→ 150.3 for anabasine-d4, respectively. The limit of quantification, selectivity, precision, accuracy, linearity, extraction recovery, matrix effect, and carry-over were evaluated according to CLSI guidelines. The validated method was used to analyze random urine samples from 268 healthy subjects.

Results:
The sample preparation time for a batch with 100 specimens was <1 hour. Chromatographic run time for each sample was 6.5 min. Our method showed excellent precision and accuracy on 4 concentrations of all the analytes; within-run CVs 2.9-9.4%, between-run CVs 1.5-9.8%, and bias <+/-10%, Linear dynamic ranges were 1.0–10,000 ng/mL for nicotine, nornicotine, and anabasine, 2.0–5,000 ng/mL for cotinine, and 5.0–15,000 ng/mL for 3-OH cotinine. The extraction recoveries ranged from 91.7% to 115.3%. No significant matrix effects or carry-over was observed. The urine concentrations of nicotine, cotinine, 3-OH cotinine, nornicotine and anabasine in non-smokers were <5.0 ng/mL, <8.7 ng/mL, <48.3 ng/mL, <1.4 ng/mL and <7.6 ng/mL, respectively.

Conclusion: Our LC-MS/MS method with simple sample preparation technique is sensitive and effective in screening of smoking status and smoke exposure in the general population.


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SHS-GC-MS Optimization for Volatile Organic Compounds Analysis in Oral Fluid and Urine

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Poster #3c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
Physiological processes naturally produce Volatile Organic Compounds (VOCs). In a pathological condition, different processes occur, causing the generation of VOCs which are not usually produced and/or changing their concentration. Thus, VOCs can be analyzed in biological samples to identify potential disease biomarkers, notably cancer.
One of the techniques used for VOCs analysis is the Static Headspace Gas Chromatography-Mass Spectrometry (SHS-GC-MS). This technique depends on numerous factors, such as incubation time, temperature, salt addition, agitation, and sample volume. Here, we study and optimize the significant factors that affect VOCs analysis in oral fluid (OF) and urine by SHS-GC-MS, using Plackett-Burman (PB) and Response Surface Methodology (RSM).

Objectives
To study and optimize the parameters for VOCs analysis in OF and urine by SHS-GC-MS.

Methods
Pooled OF and urine were analyzed in different conditions by SHS-GC-MS. The PB12 factorial design was used to evaluate how incubation time (tinc, min), temperature (T, °C), agitation (rpm), sample volume (SV, mL), pH, and salt addition (NaCl, g), affected the total response area. The significant variables obtained via PB were optimized by central composite design (CCD) and RSM. All statistical analyses were performed with Statistica 7.0.

Results and Discussion
Statistical analyses of the PB12 showed that OF significant variables were T, salt addition and SV (p < 0.05). The other factors were not statistically significant (p > 0.05). Regarding urine, only salt addition was not significant. The main reasons why the significant factors differ between OF and urine are the SV and pH. The OF SV is limited by the amount obtained in one sample collection (about 1mL), while in urine higher volumes may be analyzed. Therefore, a higher tinc and agitation may be required to increase the amount VOCs in urine headspace. Regarding the pH, several compounds are eliminated in urine as conjugates. An acidic environment may enhance the quantity of compounds in their non-conjugated form, resulting in a significant higher response area.
For OF CCD evaluation, SV was fixed at 1 mL, agitation at 250 rpm, pH was neutral (since it avoided an additional sample preparation step), and the other factors were optimized. Although tinc was not statistically significant, it was evaluated in CCD to ensure that the best results were obtained within the shortest time. The analysis of the RSM provided the best conditions: T = 95 °C, NaCl = 0.8 g, and tinc = 5 min.

Conclusion
The PB factorial design allowed us to study and differentiate the statistical significant variables in OF and urine VOCs analysis by SHS-GC-MS, and the RSM provided the OF optimized conditions. The urine optimization will be included at the poster presentation. These parameters will be used to analyze the OF and urine of healthy people and individuals with head and neck Cancers, to determine possible biomarkers of this disease.


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Comparison of Phenylketonuria Screening with a Fluorimetric Method and with Tandem Mass Spectrometry

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Poster #27b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Early detection of diseases by newborn screening (NBS) is necessary for correct and timely clinical decisions. One of the early methods for NBS of phenylketonuria (PKU) was a fluorimetric method for quantification of phenylalanine (Phe). This method is still used in many countries in south-eastern Europe. The introduction of expanded NBS with tandem mass spectrometry (MS/MS) enabled screening for many diseases, including PKU. Slovenia is now in a unique position to compare the methods because it screens for PKU with a fluorimetric method detecting Phe and also using MS/MS for expanded NBS, also measuring Phe and tyrosine.
Objectives: Evaluation of MS/MS for screening of PKU and comparison with the fluorimetric method.
Methods: Fluorimetric method was performed using the Neonatal Phenylalanine kit from Perkin Elmer. The expanded NBS method is performed on a MS/MS in MRM mode, samples prepared using a nonderivatised kit NeoBase™ 2 Non-derivatized MS/MS kit from Perkin Elmer. Cut-off of Phe for both methods was 120 µmol/L, on the MS/MS we have an additional ratio Phe/Tyr for PKU screening with the cut-off 2.15.
We compared measurements of nearly 7000 newborn blood spots. The descriptive statistics, Bland-Altman analyses and Spearman correlation coefficient were calculated. The numbers of true positives and false positives for both methods were compared.
Results: Phe concentrations were 21 – 296 µmol/L, with the mean of 46 µmol/L (MS/MS method) and 10 – 280 µmol/L, with the mean of 67 µmol/L (fluorimetric method). Spearman correlation coefficient had a value of 0.49. Bland-Altman analysis comparing MS/MS method with the fluorimetric method in absolute values had a bias 21 µmol/L (SD 15.9 µmol/L), in percent difference the bias was 36 % (SD 21 %). The fluorimetric method yielded 16 positive results, one of the patients being a true positive. The MS/MS method flagged only the one PKU patient as positive.
Conclusion: The MS/MS and the fluorimetric method have a moderate correlation and the Bland-Altman analyses show that the fluorimetric method gives higher results. Nevertheless, the cut-off for MS/MS was the same as on the fluorimetric method, because the literature data and laboratory experiences do not warrant lower cut-offs. There were no false positives by MS/MS, which will occur after screening more newborns, yet it still showed that MS/MS was better suited for PKU screening. Both methods did not have any false negatives. Our results show that MS/MS is more suited for NBS of PKU and as Phe and Phe/Tyr are screened as part of the expanded NBS, MS/MS screening for PKU is also more cost and time effective.


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Development and Validation of the First UHPLC-MS/MS Method for the Quantification of the New Anti-Ebola Drug Remdesivir: Application to Healthy Volunteers

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Poster #21h View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Aim of the work. Ebola virus disease shows a very high death rate (up to 90%) and the 2014-16 outbreak has been one of the deadliest since 1976, year in which ebola virus was identified. Nevertheless, up to now, any effective pharmacological treatment has been discovered. Some molecules are under study and, among all, remdesivir (RDV) revealed really promising and is now on fase II/III studies. Unfortunately, detailed information about RDV pharmacokinetics are still lacking and no methods for its quantification in patient’s plasma have been reported in literature.
The aim of this work is the development and validation of a method for the Therapeutic Drug Monitoring (TDM) of RDV using liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS), in order to describe its pharmacokinetics in healthy volunteers.
Materials and Methods. Briefly, to a volume of 50μl of plasma sample/calibration standard/quality control (QC) are added 100μl of internal standard (IS, a mixture of 6,7-dimethyl-2,3-di(2-pyridyl)quinoxaline –QX– and tenofovir-alafenamide –TAF–) and 600μl of methanol:acetonitrile 50:50 (v:v). After vortex and centrifuge steps, 300µL of the supernatant are diluted with 600μl of water and injected on a UHPLC system, coupled with Q-Sight 220 MS/MS detector. Chromatographic separation is obtained on a HSS T3 1.8μm 2.1x50 mm column, with a binary gradient separation of water and acetonitrile, both added with formic acid 0.05%. Positive electrospray ionization (ESI+) is used for both RDV and its ISs. The quantification MRM traces (m/z) are: 603.15>200 for RDV, 313.2>78.05 for QX and 477.20>346.05 for TAF. Validation process, according to FDA and EMA guidelines, is still ongoing: recovery (REC), matrix effect (ME), IS-normalized matrix effect, extraction efficiency (EE), accuracy, intra- and inter-day precision are being evaluated in 6 different analytical sessions. The validated method will be tested on real samples from healthy patients, enrolled in the CAPA-CT-II study, all giving informed consent.
Results. All analytes are successfully retained by the column: TAF retention time is 0.95 min (column “dead-time” is 0.32 min) while QX and RDV co-elute at 1.57 min. Preliminary data from the first four sessions are very encouraging: for remdesivir, REC resulted among 70 and 80%, ME ranged among -3 and +10%, EE was approximately 75%; accuracy and precision data are also within the limits indicated by the guidelines. RDV calibration curves resulted linear (r2 > 0.996) with 1/X weighting.
Conclusions. This method is currently being validated according to FDA and EMA guidelines, and results the first for RDV quantification. Its main features are the very short analytical run (4 min) and the very small amount of plasma required (50μl). Precipitation and strong dilution of samples (45-folds) contribute to a low instrumental contamination and low matrix effect.


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Analysis of Aldosterone by LC-MS/MS: Comparison between a Conventional Electrospray Ionization Source and a New Atmospheric Pressure Ionization

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Poster #7d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Background and aim. Aldosterone, a mineralcorticoid steroid hormone, plays a central role in regulation of blood pressure. The usual serum or plasma concentration is in the range of pg/mL, which makes the analysis rather challenging. Liquid chromatography and tandem mass spectrometry (LC-MS/MS) offer several advantages over conventional radioimmunoassay (RIA)-based assays in terms of both higher sensitivity and better specificity.
Objective. In this work we report early results on performance comparison between a conventional electrospray ionization (ESI) source and a new atmospheric pressure ionization source, UniSpray (US) (Waters Corp.) for LC-MS/MS analysis of aldosterone.
Methods. Sample extraction was performed on Oasis MAX µElution Plate (Waters) according to the application note of the producer. Chromatographic separation was performed on ACQUITY UPLC I-Class System, using CORTECS UPLC C18 column (Waters) followed by detection on TQS-Micro Tandem Quadrupole Mass Spectrometer. Standard solutions of aldosterone and its labeled internal standard were purchased by Cayman Chemical. The calibration curves were prepared in surrogate matrix of stripped human serum purchased by Chromsystems (range, 15-2000 pg/mL). Sixty five serum samples were analyzed in duplicated with ESI and US sources, and results were then compared with those obtained by the RIA method currently used in the local laboratory.
Results. The limit of detection (LOD) and limit of quantification (LOQ) defined as the lowest concentration generating a signal to noise ratio (S/N) >3 and >10 were 5 and 10 pg/mL respectively for both sources. Within-run coefficients of variations were <6% over a broad range of values (4 sample pools). The matrix effect, evaluated as peak area of extracted post-spiked aldosterone serum samples taken as percentage of extraction solvent samples spiked to equivalent concentrations displayed a RSD of 0.5%. The recovery percentage, expressed as ratio of [(Peak Area of Pre-Spike) / (Average Peak Area of n Post-Spikes)] x 100 was 64%. A mean increase in signal intensity of 51.5% and a mean decrease in S/N ratio of 48% was observed for US compared to ESI. Linear regression analysis between RIA and LC-MS/MS on the 65 routine samples yielded correlation coefficient of 0.84 for both ESI and US. The RIA assay displayed a mean positive proportional bias of 42% and 67% compared to the LC-MS/MS assay with US and ESI sources, respectively. Data obtained in US and ESI were perfectly correlated (r=0.998).
Conclusion. For the measurement of compounds such as aldosterone, where sensitivity is critical, the present LC–MS/MS method displayed optimal analytical performance, showing advantages of using US over ESI source in term of signal intensity. Further adjustments would be needed for improving extraction protocol efficiency.


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Detection of F-2 Mycotoxin Zearalenone in Human Urine. Consumption of Contaminated Cereal Crops or Doping Offence?

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Poster #2c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: Zearalenone or F-2 mycotoxin is a heat-stable, potent estrogenic metabolic product of some Fusarium and Gibberella species, found in cereal crops like maize, oats, wheat, rice and barley. Due to its similarity to naturally-occurring estrogens (17β-estradiol), zearalenone and its main metabolites (α-zearalenol, β-zearalenol, zeranol and taleranol) are considered by World Health Organization and European Commission as endocrine-disrupting chemicals and a possible cause of carcinogenesis.
Objectives: Due to its anabolic effects, zeranol and taleranol are banned in sport. The presence of this metabolites in athlete’s urine must be clearly attributed to illegal use or unintended contamination. The primary objective of this study is to develop and optimize a gas chromatography - mass spectrometry application for the detection of zeranol and/or taleranol in the presence of zearalenone mycotoxin.
Methods: The method was developed for gas chromatography –tandem mass spectrometry (GC-MS/MS) GC Trace 1310 connected to a TSQ Quantum XLS Ultra from Thermo Scientific. The GC was equipped with an HP-Ultra 1 (17m x 200µm and 0.11µm film tickness) from Agilent Technologies (USA). The temperature program was as follows: the initial temperature was 160°C hold time 2 min, increased by 5°C/min to 255°C and then by 30°C/min to 285°C (hold time 5 min) and finally by 60°C/min to a final temperature of 300°C (held 3.75 min). The transfer line temperature was set at 310°C. Helium was used as carrier gas (constant flow rate aprox.1 mL/min).
Results:The method for the detection of zearalenone and its main metabolites α-zearalenol, β-zearalenol, zeranol and taleranol was developed and validated. Both urine samples spiked with the compounds and real excretion urines were analyzed in order to test the validated method for limit of detection and matrix interference. Using this GC-MS/MS method, the analysts can discriminate between a urine sample resulting from illegal use of anabolic agent zeranol or unintended contamination.
Conclusion: Contamination of food with mycotoxins and veterinary products used as growth promoters is a global and dangerous phenomenon that could lead to unfair sanctions in sport for athletes. The detection of metabolic profile using mass spectrometry applications developed towards the differentiation between mycotoxin contamination and anabolic agent illegal administration is the solution in this case for a correct and accurate interpretation of analytical findings of zeranol in urine samples.


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Enhanced Mass Spectrometric Profiling of the Human Blood Exposome Using an Optimised Dispersive Solid Phase Extraction Protocol

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Poster #2a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: The untargeted nature of metabolomics allows measurement of biofluid chemistry related to both endogenous metabolism and host-environment exposures (i.e. the exposome). Comprehensive coverage of chemically diverse metabolites present in human blood products benefits from the use of multiple methods, each oriented toward a small molecule subset generally segregated by polarity and hydrophobicity. Whilst recent developments in LC-MS profiling methodologies have delivered numerous solutions for the analysis of polar molecules (e.g. via HILIC-MS) and complex lipids, the analysis of moderately hydrophobic and amphipathic molecules in blood products (including much of the exposome) by RPC methodology, is complicated by the suppressive effects of lipids on the ionisation of low molecular weight (LMW) metabolites. Efficient and inexpensive solutions are required for the separation of small molecules from the remaining sample matrix fit for large scale and high throughput applications.
OBJECTIVES: To develop and optimise a blood preparation protocol enabling the use of a coordinated suite of analytical assays, specifically removing lipids and protein efficiently and inexpensively, with minimal effect on other LMW metabolites to enable RPC-UPLC-TOFMS profiling.
METHODS: A lipid removal sample preparation technique was developed using a novel dispersive solid phase extraction (DSPE) technique. Factors optimised to facilitate lipid removal with minimal loss of other analytes included design of experiment(DOE) protocols for aspects of the DSPE sorbent specification, and the solvent composition used for extraction. The feasibility and robustness of the extraction methodology explored on an exemplar epidemiological plasma dataset (n=285) using well-characterised RP-UPLC-TOFMS phenotyping for high resolution detection of chemical species and data processing pipelines.
RESULTS: A rapid sample preparation method using DSPE for the removal of lipids was optimised for human blood products. DSPE provided a straightforward reproducible approach which enabled the use of uncompromised RPC-UPLC-TOFMS to complement the coverage provided by HILIC and lipid analyses. UPLC-TOFMS data on the exemplar study was processed using XCMS software resulting in 3093 detected metabolite features. Repeated observation of specific reference features from pooled QC samples throughout an analytical batch demonstrated mean retention time RSD <0.3% and mean peak area RSD <5% with no post normalisation. Finally, to demonstrate the methods suitability to explore the exposome, both endogenous metabolites and known xenobiotics were annotated, and their population prevalence reported.
CONCLUSION: The optimised lipid removal method described enables improved characterisation of the human exposome using high-throughput metabolic phenotyping platform. Additional advantages include reduced cost and increased robustness when compared to conventional solid-phase sample clean-up protocols.


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Integration of Mycophenolate and its Metabolite Analysis in Plasma Using LC-MS/MS with Full-Automated Sample Preparation

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Poster #25d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction
Currently sample preparation for the detection of drugs in biological samples by liquid chromatography-mass spectrometry (LC-MS/MS) involves complex offline extraction methods such as solid phase extraction or liquid/liquid extraction, all of which require additional sample concentration and reconstitution in an appropriate solvent. These sample preparation methods are time-consuming, often taking 1 hour or more per sample, and are more vulnerable to variability due to errors in manual preparation. Our approach to offering a high sensitivity drug detection method and timely, automated analysis of multiple samples is to use the automated sample preparation system coupled to the detection capabilities of a high-sensitivity triple stage quadrupole mass spectrometer.

Method
Mycophenolic acid and its glucuronide in plasma were verified using DOSIMYCOTM (Alsachim, France). plasma sample was loaded directly into the automated sample preparation system (CLAM-2000 Shimadzu, Japan). The CLAM-2000 was programmed to perform protein precipitation using methanol followed by filtration and sample collection. The sample is then transported using an arm from the CLAM-2000 to the HPLC without human intervention for LC-MS/MS analysis.
The treated samples were trapped using a DOSIMYCOTM C8 column and then separated by DOSIMYCO® C18 column at 65°C in 2 min.

Results
We evaluated this system using calibrator and control plasma spiked with mycophenolic acid and its glucuronide in DOSIMYCOTM and carried out concurrent analysis over a range of concentrations in 0.1 to 50 mg/L for mycophenolic acid and 1 to 250 mg/L for its glucuronide. The calibration curves that were generated had linear regression values of r2 >0.99 for each curve. As for reproducibility (N=3) at three concentrations, the deviation between theoretical values and actual measurements was less than 10%, and the CV value was also less than 10%.

Conclusion
We completed mycophenolate analysis using the automated sample preparation system coupled to LC-MS/MS. The results show the capability of the system for large sample set analyses with improved accuracy and precision by eliminating human error associated with manual sample handling.


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Confirmation Method for the Determination of Drugs of Abuse in Saliva: Validation of a RUO Kit by LC-MS/MS, Ready for Use

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Poster #28h View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Road checks carried out by the police contemplate the collection of a salivary sample, which is analyzed with first level screening methods. These semi-quantitative results must be confirmed with confirmatory techniques, such as liquid chromatography combined with mass spectrometry. The aim of this study was is to validate a method for the quantitative analysis of the major substances of abuse on a salivary sample with LC-MS / MS systems.

METHODS: The developed and validated method allows the quantification of 17 drugs of abuse (DOA): Cocaine, Benzoylecgonine, Cocaethylene, THC, Buprenorphine, 6-monoacetylmorphine, Morphine, Codeine, Methadone, EDDP, Amphetamine, Methamphetamine, MDMA, MDA, MDE, Ketamine, MBDB. The analytical procedure consists of a dilution of saliva sample with 15 internal standards (drug of abuse labelled with stable isotopes). After the centrifugation, the supernatant is directly injected in LC-MS/MS system. Multiparametric and multi levels calibrators (six levels) and controls (two levels) are supplied with the kit to ensure a stable calibration curve in the suitable range of interest for each molecule.

RESULTS: An LC–MS/MS method for determination of 17 different drugs of abuse, in saliva samples, was successfully developed and validated according to FDA guidelines for bioanalytical method validation. The method was considered to be selective: analyzing 6 blank samples there were no unexpected endogenous interferences >20% of LLOQ for all drugs, nor >5% of the IS signals. Recovery from collection devices was comprised between 91 and 110%. No matrix effect was found. The method was linear for all drugs with R2 ≥0.996 in all cases. Intra-assay (CVs variable from 5.67 to 6.85%) and inter-assay (CVs variable from 5.84 to 7.25%) reproducibility analyses demonstrated accuracy and precision within acceptance criteria. Carry-over and interferences were negligible. Lower limits of quantitation are below the limits defined by international guidelines (European Guidelines for Workplace in Oral Fluid, Version 2.0, by European Workplace Drug Testing Society, 2015) and Italian national laws. Samples were tested for stability and resulted stable at least six month at -20°C and one week at +4°C.

DISCUSSION: The research use only (RUO) version of this new kit (from Eureka Lab Division) for the determination of drugs of abuse in saliva has been successfully validated according to FDA guidelines in a collaborative study and is now becoming applied to real samples. This kit, thanks to its easy of use and its performances in terms of accuracy and precision could become a reference standard for the laboratories involved in toxicology and confirmation tests for drug of abuse.


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Confident Quantification of Steroids: Analysis in Human Plasma or Serum by LC-MS/MS for Clinical Research

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Poster #2d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION
In this report, a robust, reliable LC-MS/MS method for clinical research is developed for the quantification of eight steroids in human plasma or serum. The analytical method includes 11- and 21-deoxycortisol, 17- and 21-hydroxyprogesterone, androstenedione, cortisol, dehydroepiandrosterone sulphate (DHEAS), and testosterone.
OBJECTIVES
Development and implementation of a robust, reliable, sensitive analytical method for quantification of eight steroids in human plasma or serum using the Thermo Scientific™ TSQ Quantis™ triple quadrupole mass spectrometer.
METHODS
Method performance was evaluated using the ClinMass® LC-MS/MS Complete Kit from RECIPE Chemicals + Instruments GmbH (Munich, Germany) in terms of linearity of response within the calibration ranges, carry over, accuracy and intra-assay precision for each analyte. Samples were extracted by protein precipitation followed by LC separation on a Thermo Scientific™ Transcend™ II LX-2 system using mobile phases and analytical column provided by RECIPE. Total runtime was 7.0 minutes. Analytes and internal standards were detected by selected reaction monitoring (SRM) on a TSQ Quantis triple quadrupole mass spectrometer with heated electrospray ionization operated in positive mode. Data were acquired and processed using Thermo Scientific™ TraceFinder™ 4.1 software.
RESULTS
The method proved to be linear in the calibration ranges covered by the calibrators. It was not possible to detect the lowest calibrator for 17-hydroxyprogesterone but the method was linear in the range calibrator 2 – calibrator 6. The maximum registered carry over was 0.08% with the exception of androstenedione which showed a value of 0.36%. The data demonstrated outstanding accuracy of the method with the percentage bias between nominal and average back-calculated concentration for the used control samples ranging between -4.4% and 5.3%. The %CV for intra-assay precision was always below 5.7% for all the analytes.
CONCLUSIONS
A robust, reliable LC-MS/MS method for clinical research for the quantification of eight steroids in human plasma or serum was developed and implemented. The ClinMass LC-MS/MS Complete Kit from RECIPE ensured increased confidence in the result that was obtained. The method was analytically validated on a Transcend II system connected to a TSQ Quantis triple quadrupole mass spectrometer. The sample preparation procedure utilized in this method uses quick and simple offline protein precipitation with concomitant internal standard addition. The described method meets research laboratory requirements in terms of sensitivity, linearity of response, accuracy, and precision.


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A UHPLC-MS/MS Method for the Simultaneous Quantification of Ten Directly Acting Anti-HCV Drugs in Patient Plasma

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Poster #20f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: To date, the infection by Hepatitis C Virus (HCV) affects more than 130 million patients worldwide and causes hepatic cirrhosis, hepatocarcinoma and liver transplantation. In the recent years, Directly Acting Antivirals (DAAs) greatly improved the effectiveness of anti-HCV treatments. Despite this, some issues concerning patients with comorbidities and polytherapies (eg. drug-drug interactions) are still present. For this reason, measurement of DAAs concentrations in patients plasma could be useful for the pharmacokinetic research or Therapeutic Drug Monitoring (TDM).
Nevertheless, no method is available in literature to quantify all the new DAAs.
Aim: The aim of this work was the validation of a UHPLC-MS/MS multiplexed method to quantify 10 currently administered anti-HCV drugs.
Materials and Methods: Briefly, 200 μL of plasma (both standards, quality controls and patients samples) were added with 50 μL of Internal Standard (1 μg/mL of thymidine, 100 ng/mL of 6,7-dimethyl-2,3-di(2-pyridyl)quinoxaline, D4-Daclatasvir and D3-Omditasvir) and 400 μL of 1% Phosphoric Acid. After mixing and centrifugation, the supernatant was loaded on Oasis ® HLB SPE 30 mg plates (Waters, Milan), previously activated and equilibrated.
After a washing step with 200 μL of pure water, elution was obtained with 350 μL of a mixture of acetonitrile:methanol 60:40 v:v, diluted with 400 μL of water + 0.05% formic acid and 4 µL were injected in the LX-50 ® chromatographic system (Perkin Elmer). Chromatographic separation was obtained with a 7 minute gradient of water and acetonitrile, both acidified with 0.05% of formic acid, on an Acquity ® HSS T3 1.8 μm 2.1 x 100 mm (Waters, Milan), maintained at 45°C. The mass instrument was a QSight 220 ® (Perkin Elmer) and the quantification was performed by multiple reaction monitoring (MRM) with ESI positive, except for glecaprevir and dasabuvir, which were ionized in negative mode.
Results: The drugs were successfully recovered by SPE and chromatographically separated. All extraction recoveries and matrix effect data resulted consistent (>80%) and contained (<20%), respectively, and reproducible (both CV% < 15%). Accuracy, intra- and inter-day precision values resulted within the limits indicated by EMA and FDA guidelines. Calibration curves were linear (R2 > 0.996) for all the considered drugs. Stability studies are still ongoing. The method is now being applied to a clinical pharmacokinetic study (KINETI-C), resulting useful for the identification of clinically relevant drug-drug interactions.
Conclusion: The described method is the first capable of simultaneously quantifying all the most used anti-HCV drugs, resulting widely applicable in both the pharmacokinetic research and clinical TDM context.


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Prostate Cancer Metabolic Alterations Induced by Zika Virus

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Poster #5b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Zika virus (ZIKV) is a flavivirus transmitted by Aedes aegypti mosquito, with high incidence of cases on Americas between 2015 and 2016. Although 80% of the cases are asymptomatic, ZIKV infection was associated to neurological complications such as Guillain-Barré syndrome and microcephaly. Based on these reports several initiatives started to understand viral infection process in human and mosquito cells. During experimental investigations it was demonstrated that ZIKV can impair neuronal growth, reduce neural stem cell and even mediate cell death. A hypothesis about the oncolytic potential of ZIKV due its ability of cell growth impairment was raised and later confirmed by in vitro and in vivo studies with glioblastoma cells. The antiproliferative effect of a ZIKV prototype (ZVp) was tested for several types of tumor cell resulting in ZVp activity against prostate cancer cells (PC-3). However, little is known about the cellular mechanisms associated prostate cancer cell death induced by Zika moieties.
Objective: Determine prostate cancer cell line (PC-3) metabolic alterations induced by Zika virus particle using high resolution mass spectrometry (HRMS).
Methods: A PC-3 cell in vitro model was exposed to ZVp for 24 hours and a group of non-exposed cells was used as control. Cells and supernatant were collected and the metabolites were extracted, ionized and directly injected in a HRMS instrument, ESI-LTQ-XL Orbitrap Discovery (Thermo Scientific, Bremen, Germany). The analysis was performed at the mass range of 400-1200 m/z in the negative and positive ion mode. The spectral data was analyzed using a Partial Least Squares Discriminant Analysis (PLS-DA). A VIP score list (Variable Importance in Projection) from MetaboAnalyst 4.0 software was used to determine the characteristic ions for ZVp exposed group. Using online databases potential biomarkers were identified (error <2ppm) and confirmed by tandem MS experiments.
Results: PLS-DA showed a marked separation between PC-3 exposed and non-exposed groups, suggesting discriminant molecules involved ZIKV induced cell alterations. The 20 proposed chemical markers translate lipid metabolism remodeling associated with ZIKV interaction with cell, inflammatory mediators and inductors of cell death. In addition, based on markers we proposed the involvement of one carbon metabolism, porphyrin pathway and protein glycosylation on ZIKV antiproliferative effect. The versatility of the metabolomic screening helped to indicate pathways that may be involved with ZIKV antiproliferative effect and are not so obvious for a first target study.
Conclusion: To our knowledge this is the first metabolomic investigation of ZIKV interaction with prostate cancer cells. Metabolomic strategies associated with HRMS have been supporting advances in ZIKV research, bringing innovation to viral infection biomarkers elucidation, developing diagnostic methods and understanding of ZIKV mechanisms and oncolytic potential.


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Simultaneous Measurement of 18 Steroids in Human or Mouse Serum by LC-MS/MS to Profile the Classical and Alternate Pathways of Androgen Synthesis

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Poster #23h View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction:
Steroid measurement by LC–MS/MS now widely accepted as the method of choice for quantifying endogenous steroids including bioactive androgens, as well as their precursors
and metabolites. The alternate, or backdoor, pathway of DHT synthesis has recently been recognized as proving a testosterone-independent route for DHT synthesis bypassing the classical pathway. We developed a rapid and versatile liquid chromatography–tandem mass spectrometry (LC–MS/MS) method to simultaneously quantify key steroids in human or mouse serum involved in either the classical or backdoor androgen synthesis pathways.

Methods information:

The LC–MS/MS analysis is based on reversed-phase chromatographic separation of the injected sample followed by gradient elution and detection of the 18 targeted steroids using triple quadrupole mass spectrometric analysis.
The liquid chromatography system was a Shimadzu Nexera UHPLC (Shimadzu Scientific Instruments, Columbia, MD, USA) with a Restek Raptor biphenyl column (100 cm×2.1 mm, 2.7 μm; cat#9309A12) with Raptor biphenyl guard cartridge (cat# 9309A0252). The solvents used were; A: Milli-Q water, B: methanol, and C: toluene (dopant). An API-5000 triple-quadruple mass spectrometer (Applied Biosystems/MDS SCIEX, Ontario, Canada) equipped with an atmospheric
pressure photoionization (APPI) source was operated in both positive and negative ion modes for the analysis. The APPI system consisted of a 10 eV krypton discharge lamp with dopant (toluene).

Serum (200 μL) fortified with isotopically labelled internal standards underwent liquid–liquid extraction (LLE) with MTBE and extracts were analysed on a LC–MS/MS. The targeted steroids for quantification were testosterone (T), dihydrotestosterone (DHT), 5α-androstane-3α,17β-diol (3α diol), 5α-androstane-3β,17β-diol (3β diol), dehydroepiandrosterone (DHEA), androstenedione (A4), androsterone (AD), estradiol (E2), estrone (E1), progesterone (P4), pregnenolone (P5), androstenediol (Adiol), 17-hydroxyprogesterone (17-OHP4) and 17-hydroxypregnenolone (17-OHP5), corticosterone (B), cortisol (F), allopregnanolone (Allo-P5) and dihydroprogesterone (DHP).

Results:
The limits of quantification (LOQ) were 5 pg/mL for E2 and E1, 25 pg/mL for T, 50 pg/mL for A4 and
0.10 ng/mL for DHT, 17OHP5, P4, P5, AD, Adiol, DHEA, AlloP5 and 0.20 ng/mL for 17OHP4, 3α diol, 3β diol, DHP, 0.25 ng/mL for B and 1 ng/mL for F. Accuracy, precision, reproducibility and recovery were within acceptable limits for bioanalytical method validation. The method is illustrated in human and mouse, male and female serum.

Conclusions:
The method is sufficiently sensitive, specific and reproducible to meet the quality criteria for routine laboratory application for accurate quantitation of 18 steroid concentrations in male or female serum from humans or mice for the comprehensive profiling androgen synthesis and metabolism pathways.


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Biomarker Analysis by Mass Spectrometry and Artificial Intelligence Techniques of Obese Human Plasma

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Poster #6b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

<b>Introduction</b>
Obesity is characterized as a worldwide epidemic, accounting for more than 600 million diagnosed with obesity. It occurs due to an energy imbalance resulting in the accumulation of fat in the cells of adipose tissue. Clinical recognition of obesity already has pre-established parameters, but the involvement of metabolic variations makes functional diagnosis and prognosis difficult. Although it's possible to classify individuals from new diagnostic methods, these methods do not contemplate all stages of the metabolic process related to adipogenesis. The metabolomics complement the studies in the area of genomics and proteomics, analyzing the final products of the cellular metabolic pathways. Therefore, the aim of this study is the determination of biomarkers present in the plasma of obese patients by mass spectrometry.

<b>Methods</b>
To carry out the project, 90 volunteers of both sexes with diagnosis of overweight and obesity were selected. The participants were selected according to the Body Mass Index (BMI) with BMI individuals above 26 kg / m². For the control group, 90 volunteers of both sexes, eutrophic and free of obesity-associated comorbidities, were selected. From each individual of the groups, a 10mL blood tube with heparin was collected. From this material, 100μL of plasma was used for metabolomic analysis. Plasma samples were immersed in organic solvent (CH3OH) and subjected to chemical protonation or deprotonation. They were then analyzed in Mass Spectrometers MALDI-LTQ-MS (Thermo Scientific) and LTQ-Orbitrap Discovery (Thermo Scientific). Chemical markers will be determined from a machine learning algorithm (Random Forest). Random Forest is a robust and reliable classification method with high predictive performance and low generalization error that fits multiple decision trees and chooses a class that best aggregates the results of those trees.

<b>Results</b>
The mean BMIs for the non-obese and obese groups were 22.3 kg/m2 (SD: ± 2.8; range: 17.4-32.0 kg/m2) and 33.3 kg/m2 (SD: ± 6.5; range: 25.1-66.1 kg/m2), respectively (p<0.0001). The body fat percentage (BF%) average in non-obese and obese groups was 21.7% (SD: ± 3.5; range: 13.7-29.9 %) and 40.3% (SD: ± 9.2; range: 24.9-62.0 %), respectively. The waist circumference average in obese group was 107.1cm (SD: ± 14.6; range: 75-149 cm). The non-obese group had no comorbidities (high blood pressure or diabetes), whereas 15 (37.5%) had hypertension and 7 (17.5%) had diabetes in the obese group. The samples were analyzed and the data collected for the accomplishment of the statistical analysis. The chemical markers of the obese group were determined by random forest.

<b>Conclusions & Discussion</b>
From the algorithm, 8 specific markers were identified for the obese group. We are now in the stage of elucidation of the molecules and their metabolic pathways.


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Mass Spectrometric Imaging of Cysteine Rich Proteins in Human Skin

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Poster #21g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: Looking insight pathological processes, metallothioneins (MTs) are considered to be potential biomarkers for monitoring of a development of various types of diseases, such as cancer. The early identification of the MTs in biological tissues could be important tool for the estimation of appropriate clinical therapy.

Objectives: The aim of this study was to investigate the application of matrix assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) together with immunohistochemical analyses (IHC) using MT-1/2 antibody for MT detection in biopsy specimens of human skin.

Methods: Formalin-fixed paraffin-embedded (FFPE) tissue blocks of various types of skin cancers were selected for analysis. Normal skin was derived from an 83-year-old female patient, who had a keratoacanthoma on her forearm. The resection margin free of any tumour cells was used for the study. Basal cell cancer (basalioma solidum et cysticum) was localized on the shoulder of a 61-year-old male patient. Superficially spreading malignant melanoma with Breslow tumour thickness 2.76 mm, Clark level III, 0–2/hpf mitotic activity (pT3a) was removed from the thigh of a 47-year-old male patient. Grade 2 cutaneous squamous cell cancer of an 86-year-old female patient was localized on her nose. Melanocytic nevus was removed from the chest of a 45-year-old female patient. FFPE tissues were histologically characterized, analyzed by MALDI MSI, and immunohistologically stained.

Results: Principal component analyses of MSI data revealed differences in the peptide/protein profiles separating healthy skin from the carcinoma specimens. Statistically significant ion peaks at m/z 6038, 6300, 6676, and 7026 were more frequently detected in squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and melanoma. Using IHC, we found that MT-1/2 was significantly higher in SCC and melanoma compared to healthy skin. Surprisingly, significantly low levels of MT-1/2 were found in BCC.

Conclusion: The results indicate important role of MTs in melanoma occurrence and progression. There are hidden processes associated with MTs based on differences of the occurrence of the MS peaks, which could be associated with cycling of MTs isoforms. In conclusion, our results contributed to the basic knowledge on protein distribution in histologically specified regions in skin cancer tissues.


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Drugs of Abuse Screening and Quantification Directly from Urine Using Paperspray Technology

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Poster #20i View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction
PaperSpray is a rapid analysis technique which is particularly beneficial for the analysis of compounds in biological matrices, such as blood or urine. Because no sample preparation is required, and analysis times are as short as 1-2 minutes, this technique offers a strong competitive advantage over traditional methods which rely on chromatographic separation. Of particular interest in the clinical community are screening assays, which require short turnaround times and the ability to screen for multiple compounds in a single run. Here we present a method for rapid screening of 19 drugs of abuse compounds directly from dried urine spots, as well as quantification of 2 out of the 19 compounds.
Methods
For the screening method, a total of 19 compounds (Opiates, Amphetamines, Cocaine and PCP) were spiked into donor urine. Isotopically labelled internal standards were added. 4 concentration levels were prepared: at cutoff, 2 times higher than cutoff, 5 times lower than cutoff, and blank. Additionally, calibrator samples for cocaine and its metabolite benzoylecgonine were spiked into urine, covering the concentration range of 5-1000 ng/mL. For the quantification, QC samples were prepared at 3 additional concentrations. 8 uL of the respective urine sample was spotted onto paper for analysis. The spray solvent was 90% acetonitrile, 10% water, and 0.01 % acetic acid. Data was acquired for 1 min per sample, and each concentration level was measured 5 times for screening, and 3 times for quantitation. The Thermo Scientific™ TSQ QuantisTM MS was used for data acquisition, and TraceFinderTM was used for data analysis.
Results
All 19 compounds, met their respective screening cutoff levels (≤15% RSD of response ratio at the cutoff level, and the absolute AUC at least 4x higher than the AUC of the matrix blank). For Cocaine and Benzoylecgonine, calibration curves were constructed by integrating the resulting chronogram from 0.1 – 0.9 min. Both curves are linear over the tested concentration range and meet precision and accuracy requirements at the lowest calibrator level of 5 ng/mL (LOQ). All QC samples (low, middle, and high) are within 10% accuracy and 5% RSD for both, cocaine and benzoylecgonine.
Conclusion, References, Acknowledgements
PaperSpray technology can be used as a rapid screening method for drugs of abuse directly from dried urine spots. No sample preparation other than spiking an internal standard and spotting the urine samples on the paper is required. A total method length (analysis time + automated sample handling time) of 1.5 minutes makes it a highly efficient and competitive screening method.


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Lipid Composition of Cancer-Derived Extracellular Vesicles and its Potential for the Identification of Body Fluid-Based Biomarkers for Breast Cancer diagnosis

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Poster #15d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction:
Extracellular vesicles (EV) are secreted by cancer cells and are found in high concentrations in body fluids of cancer patients. These EV (including exosomes and microvesicles) play an important role in tumour development, progression and therapeutic response. EV are delimited by a lipid bilayer and contain proteins, nucleic acids and metabolites. Although EV have a great potential as liquid biopsies for early detection of breast cancer, the lipid composition of breast cancer-derived EV is unknown. The aim of this study is to characterise the lipid composition of EV released by breast cancer cells and its potential for the identification of body fluid-based biomarkers for breast cancer diagnosis.

Methods:
The lipid composition of EV and their parental cells were evaluated for nine breast cancer and two non-cancerous mammary cell lines. EV were isolated by size-exclusion chromatography. The shape of the EV was confirmed by cryo-electron microscopy and the number and size was defined by nanoparticle tracking analysis. Lipids extracted from EV and their parental cells were analysed by reverse-phase liquid chromatography mass-spectrometry. The data acquisition was performed in both positive and negative electrospray ionisation modes.

Results:
We found that breast cancer-derived EV were enriched in sphingomyelins, ceramides and lysophosphatidylethanolamines when compared to their parental cells. Furthermore, phospholipids such as phosphatidylcholine and phosphatidylethanolamine were found to be abundant in cancer-derived EV. Unsupervised and supervised analyses showed that EV released by breast cancer cells can be distinguished from those released by non-cancerous cells based on their lipid profile.

Conclusions:
This is the first global lipid profiling of EV released by breast cancer cell lines. Our findings demonstrate the potential of the lipid content of cancer-derived EV for the identification of biomarkers for breast cancer detection.


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Determination of Membrane Lipid Gangliosides in Human Serum and Cerebral Organoids

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Poster #5c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: Gangliosides (GSs), sialic acid-containing glycosphingolipids, are essential components of cellular membranes, especially in neuronal cells. Besides affecting the function of the membrane in which they are located, these amphiphilic lipids modulate a variety of biological functions through transmembrane signalling.1 GSs content and composition change during aging, which is the most important risk factor for several neurodegenerative diseases.2 Cerebral organoids are a useful model to study composition of membrane GSs in brain tissue or specific cell populations. The brain tissue abundance of GSs expectedly correlates with circulating levels in peripheral blood and perhaps the determination of GSs in human serum can serve as clinically significant marker.
Objectives: The primary aim of our study was to develop an analytical protocol for extraction and detection of selected GSs (aGM1, GM1, GM2, GM3, GD1a, GD1b, GT1b, GQ1b, GD2, and GD3) in cerebral organoids and human serum.
Methods: Several extraction solvent systems were tested (i.e. Folch method,3 water-saturated ethyl acetate, and 80 % of 2-propanol/methanol) to achieve optimal extraction efficiencies. A commercially available pooled human serum and cerebral organoids (~45 days aged) were analysed. SRM-MS assays on a triple-quadrupole mass spectrometer (6495, Agilent Technologies) were used to detect GSs. Stable isotopically labelled internal standards were used for absolute quantification in biological samples.
Results: All targeted GSs were profiled quantitatively in cerebral organoids. The most abundant species in human serum were GM3, GM2, GD1a/b, GD3 and GT1b.
Conclusion: The study presents an analytical protocol to quantify GSs and its application to a biological material (i.e. human serum and cerebral organoids). It i a useful tool for investigation of aging induced alterations in membrane GS composition, essential to elucidate the pathophysiology of neurodegenerative diseases.

(1) Ledeen, R.; Wu, G. Gangliosides of the Nervous System. Methods Mol. Biol. 2018, 1804, 19–55.
(2) Kolter, T. Ganglioside Biochemistry. ISRN Biochem 2012, 2012, 506160.
(3) Folch, J.; Lees, M.; Sloane Stanley, G. H. A Simple Method for the Isolation and Purification of Total Lipides from Animal Tissues. J. Biol. Chem. 1957, 226 (1), 497–509.

This work was supported by the Grant Agency of Masaryk University (GAMU project No. MUNI/G/1131/2017), The Czech Health Research Council, AZV project No. NV19-08-00472 and the Czech Ministry of Education, Youth and Sports (CETOCOEN PLUS CZ.02.1.01/0.0/0.0/15_003/0000469 and LM2015051).


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Cross-modality Single-pixel Correlation of Multimodal Imaging Mass Spectrometry of Prostate Cancer

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Poster #21d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction
Using MALDI imaging mass spectrometry (IMS), our group have been investigating cancer associated distribution patterns of lipids and proteins in mice prostate cancer tissues. Prostate cancer is one of the most common cancer diagnosed, and it is one of the main causes of cancer-related death in men in the United States and Europe. While surgery, radiation and other therapies have increased survival rates, the 5 years survival rate is still about 30% for patients with the metastatic disease.
Here were present novel strategies for objective evaluation of data processing methods for multivariate analysis of MALDI IMS datasets of mice metastatic prostate cancer tissues. The strategy employs region-based active contours segmentation based on the PCA scores matrix to provide class information for Orthogonal Projections to Latent Structures discriminant analysis (OPLS-DA) modelling. Processing methods can then be compared by the quality metrics of the respective multivariate models. This workflow provides an unbiased strategy for sensitive annotation of anatomical regions of interest in prostate cancer tissues and quantitative comparison of processing procedures for multivariate analysis.

Methods
Fresh frozen tissue of rat prostate affected by highly metastatic Dunning R3327-MLL cancer cells was cut into 12 μm thick sections in a cryostat microtome and collected onto a glass slide. The 1,5-diaminonaphthalene matrix was applied using a dedicated HTX TM matrix sprayer. IMS lipid data acquisition in negative and positive ion mode was performed.

Results
Multivariate image analysis of the MALDI IMS date using principal component analysis provided structural features. This in turn allowed precise segmentation of anatomical features on the PCA data scale using a region-based active contour segmentation algorithm. This class information was supplied to OPLS-DA modelling, which provided quality metrics i.e. predictive ability of OPLS-DA models to quantitatively compare the applied processing methods. Logarithmic transformation reduced the heteroscedastic noise structure of the data resulting in improved multivariate models and the visualization of detailed anatomical features.

Discussion and Conclusions
We developed a multivariate strategy for robust regions of interest (ROI) feature detection, image segmentation, and classification that enabled quantitative comparison of ROI-associated biochemical localisation patterns in prostate cancer tissue. Quantitative comparison of the applied methods allow us to demonstrate how data processing methods impact feature detection and annotation.


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The Effect of Concentrations of Major Metabolites on Quantification of Minor Volatile Compounds in Breath by SESI-MS

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Poster #14c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Secondary electrospray ionization-mass spectrometry (SESI-MS) is a highly sensitive innovative real time technique for analyses of complex gaseous mixtures such as human breath. Accurate quantification of gaseous analytes cannot be currently done without internal standards. Breath is a complex mixture containing several hundreds volatile organic compounds (VOCs) present at concentrations from pptv to ppmv. When compounds are present at elevated concentrations that can significantly decrease the reagent ion signal in SESI, the secondary and ternary reactions take place, additional products are observed and quantification based on calibration is compromised. However, accurate quantification of trace gases in air based on chemical ionisation by reagent ions and ion-molecule reaction kinetics can be achieved by selected ion flow tube mass spectrometry (SIFT-MS) that is less sensitive than SESI-MS.

OBJECTIVES: The primary objective of this study is describe the effect of elevated concentrations of acetone, ammonia and ethanol (as measured by SIFT-MS) on quantification of minor volatile analytes by SESI-MS. The specific objective is to understand the general principles of gas phase ion chemistry at atmospheric pressure that underlies SESI quantification.

METHODS: Gaseous mixtures simulating breath, natural and spiked breath samples were analysed using SESI-MS and in parallel by real-time quantitative SIFT-MS method. The peak heights in SESI-MS spectra were related to SIFT-MS measured concentrations and changes in SESI sensitivity of analyses of minor volatile metabolites thus were calculated.

RESULTS: Sensitivities for SESI-MS quantifications were obtained for a range of compounds including acetic acid, sulphur compounds, alcohols and ketones as a function of concentration of ammonia, acetone and ethanol spiked to the breath sample in range up to 3000 ppb (10x physiological baseline, for acetone corresponding to ketogenic state). The data show that sensitivity for acetic acid is reduced by a factor of 1.2. For methanethiol the effect is similar at a factor of 1.3.

CONCLUSION: Presence of acetone, ammonia and ethanol in breath affects SESI-MS quantification by up to a factor of 1.3 due to complex ion chemistry taking place in humid atmospheric pressure air. This effect can be explained by kinetics of gas phase ion-molecule reaction sequences involving hydrated protonated molecules.
ACKNOWLEDGEMENT: Funded by GACR project 18-12902S.


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Ultra-low Level Analysis of Aldosterone in Plasma Using the Xevo TQ-XS for Clinical Research

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Poster #28c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Background: Aldosterone is a mineralocorticoid steroid hormone that plays a key role in the regulation of blood pressure. We developed a LC-MS/MS method for the measurement of plasma aldosterone for clinical research purposes. An analytically sensitive method was developed using a mixed-mode Solid Phase Extraction (SPE) sorbent in 96-well plate format. Automated extraction was employed, enabling high throughput of samples. Samples were injected onto an ACQUITY UPLC™ I-Class system with separation on a Waters™ CORTECS™ C18 2.7µm column with VanGuard™ precolumn using an ammonium fluoride(aq)/methanol gradient. Detection was performed using a Waters Xevo™ TQ-XS mass spectrometer to help quantify very low physiological concentrations of aldosterone.
Methods: Aldosterone certified reference material purchased from Cerilliant (Round Rock, TX) was used to create calibrators in stripped pooled serum purchased from Golden West Biologicals (Temecula, CA). QC material was prepared in K2EDTA plasma purchased from SeraLab (Haywards Heath, UK). EQA samples from NEQAS (Birmingham, UK) were analysed to evaluate analytical method bias. 200µL samples were pre-treated with zinc sulphate in methanol, followed by dilution with water. SPE was carried out with a Waters Oasis™ MAX µElution 96 well plate to reduce ion suppression and concentrate the samples without the need for evaporation. Automated extraction was performed using the Tecan Freedom Evo 100/4 Liquid Handler. Using an ACQUITY UPLC I-Class system, samples were injected onto a CORTECS C18 2.7µm 2.1 x 100 mm column with VanGuard™ precolumn using a 0.05mM ammonium fluoride(aq)/methanol gradient elution profile and quantified with a Waters Xevo TQ-XS mass spectrometer.
Results: The method demonstrated no significant carryover or matrix effects and was shown to be linear from 3 – 1500 pg/mL for aldosterone. Analytical sensitivity investigations indicate the analytical sensitivity of this method would allow precise quantification (<20%) at 3 pg/mL with a S/N (PtP) > 10. Coefficients of variation (CV) for total precision and repeatability on 5 occasions for low (13 pg/mL), mid (103pg/mL) and high (1057 pg/mL) QC material were all ≤6.3% (n = 25) for aldosterone using automated extraction. Analysis of EQA samples (n=15) demonstrated a mean bias of -3.2% compared to the EQA MS laboratory mean for the samples.
Conclusions: We have successfully quantified aldosterone in plasma using an automated SPE protocol with LC-MS/MS analysis, for clinical research purposes. The method demonstrates excellent sensitivity, linearity, precision and bias with minimal matrix effects.
For Research Use Only. Not for use in diagnostic procedures.


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Monitoring of Human Procalcitonin by Functionalized MALDI Surfaces

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Poster #16b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION:
Increase of procalcitonin (PCT) concentration in human bloodstream is an valuable biomarker of sepsis. There are several commercialy available assays for determinination of concentration level of PCT. Our approach combines in-situ enrichment of procalcitonin by functionalized surfaces and MALDI mass spectrometry. The novel method might be fast, robust and low-cost alternative to standard approaches with a benefit of individual PCT forms determination.
OBJECTIVES:
Our interest is the application of functionalized MALDI surfaces for clinical analysis of PCT in human serum. Its concentration in bloodstream is under physiological conditions bellow the limit of detection of current methods. During sepsis, its concentration increases dramatically and PCT can be monitored.
METHODS:
Human serum samples with PCT were pre-concentrated using acetonitrile in a ratio of serum/water/acetonitrile 1:2:4.5 (v/v). Aqueous phase was dried and re-suspended in LC-MS grade water (5 µl). Two microliters of the sample were incubated on MALDI chip functionalized with anti-procalcitonin antibody for 60 minutes in humidity chamber. After incubation, the MALDI chip was washed three times in PBS, rinsed in distilled water and let dried at RT. Dihydroxyacetophenone matrix was applied on each spot. Procalcitonin detection was performed by Autoflex speed MALDI – TOF MS (Bruker Daltonics) in linear positive mode.
RESULTS:
Low concentration of PCT in human serum does not allow its direct detection by functionalized MALDI surfaces. Several workflows for PCT pre-concentration were optimized and successfully applied to precipitate the majority of serum proteins while keeping PCT in aqueous phase. By using this pre-concentration step followed by in-situ enrichment of PCT on functionalized surfaces, we were able to detect PCT at a concentration level of 0.5 fmol/μl (10 ng/ml).
CONCLUSION:
Our data suggests that imunoaffinity surfaces in combination with MALDI mass spectrometry are potentionally useful for detection of PCT in human serum. Further optimization of the technology and workflow is needed.


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Validation of the Doubly-labelled Water Method to Determine Total Energy Expenditure in a Rat Model

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Poster #22g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: The global increase in obesity is still one of the major health challenges, which drives the growing interest in understanding factors that influence total energy expenditure. Doubly-labelled water is commonly used to measure total energy expenditure in animals and humans. After a bolus dose of doubly-labelled water, hydrogen leaves the body primarily via water turnover, whereas oxygen is depleted both via water turnover and via CO2-exhalation. The excess disappearance rate of 18O relative to deuterium as a measure for the CO2-production rate is used as indirect measure of total energy expenditure.

Objectives: We aimed to validate the doubly-labelled water method to determine the total energy expenditure in a rat model using a metabolic cage, and to establish a sample preparation method suitable for low-volume plasma samples.
Methods: Intraperitoneal injection was used to administer a mixture of H218O and D2O in 6 rats housed in metabolic cages (PhenoMaster). We collected rat plasma samples over a period of 5 days to measure the total energy expenditure. Sample preparation was adjusted for low-volume rat plasma samples by investigating ultrafiltration sample preparations with 10, 30 and 50 kDa cut-off membranes. In addition to standard Isotope-Ratio-MS measurement, we used laser spectrometry to determine 18O and deuterium-enrichment. Rate constants and pool sizes were calculated using the slopes and intercepts of the log-transformed spectrometric data to determine the CO2-production.

Results: Total energy expenditure assessed by the doubly-labelled water method was in accordance with CO2-production data from the metabolic cage. Data showed that cut-off sizes of the ultrafiltration membranes did not influence measurement accuracy. Mass spectrometry and laser spectrometry data were well correlated independent of the used sample preparation method with correlation coefficients of 0.999 for both isotopes and a slope of 1.01 for deuterium and 0.98 for 18O.

Conclusion: Total energy expenditure measurements in rats by doubly-labelled water were validated using a metabolic cage and we successfully established a sample preparation method for low-volume plasma samples. The doubly-labelled water method can thus be used for reliable energy expenditure measurements covering typical observation times of one or more weeks in humans. The method is also a promising tool to assess the effect of routine activities or exercise on total energy expenditure in a home environment in obese patients.


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Automated Sample Pretreatment for the Analysis of Synthetic Cannabinoids in Urine with LC-MS/MS

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Poster #20h View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction:
LC-MS/MS is a reliable, fast and highly sensitive technique used for multi analyte quantification of synthetic cannabinoids (SC). The analysis of the SC: JWH 018-M-N-5-OH, JWH 018-M-N-5-acid, JWH 073-M4-OH, JWH 073-M-N-B acid, JWH 081-5-OH, JWH 081-5-acid, JWH 122-5-OH, JWH 210-5-acid, JWH 250-5-OH, JWH 250-5-acid, AB-PINACA-OH, AB-PINACA-acid, AKB-48-OH, AKB-48-acid and PB-22-OH is performed for abstinence testing. Today’s laboratories are challenged with delivering high standards of laboratory services with fewer resources, so full workflow automation is key to delivering highly reliable results in the required timeframe. In particular, sample pretreatment is a bottleneck requiring several tedious pipetting steps that can lead to errors. This poster describes in detail sample pretreatment automation for the analysis of synthetic cannabinoids using the HAMILTON STARlet sample pretreatment robot combined with a Sciex QTRAP 3200.
Results:
The application was successfully developed as a walk away method; loading and unloading are the only manual steps. The automated workflow can handle up to 70 barcoded samples per run without the need of a worklist. The cooling module allows the samples to be stored in the instrument for at least 72 hours after processing and before analysis (decrease: 1.3-9.0%). It could be shown that the automated sample pretreatment with the HAMILTON STARlet performs very well with acceptable bias (0.5-14.7%) and precision (6.6-14.1%). The results correlated to those obtained with manual processing (R²: 0.7968-0.9195). The reduced correlation coefficients are due to the use of Protein LoBind plates compared to silanized vials in manual sample pretreatment. The synthetic cannabinoids have the property to bind rather well to plastic surfaces, however the LoBind plates have the best comparability to manual sample pretreatment. The results from conventional deep well plates differed more than 70%.
Conclusion:
With our automated method we show that sample pretreatment can be immediately implemented without the need for additional personnel.


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Evaluation of Simplified Workflows for Hair Matrix Extraction Prior to UHPLC-MS/MS Analysis

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Poster #23d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction
Although not used routinely as per other matrices such as blood or urine, hair does have advantages in that the matrix can indicate prolonged drug exposure. This can provide valuable information with respect to therapeutic drug regimens or in abused drug abstinence cases.

Methodology
Hair samples of 10-20 mg were weighed and transferred to 2 mL reinforced tubes prior to the addition of 2.4 mm metal beads. Methanol (1 mL) was pipetted, either with or without pH modification and the samples were subjected to micro-pulverization using the Lysera bead disruption system. Methanolic extracts were cleaned-up using supported liquid extraction, ISOLUTE® SLE+ in 400 µL capacity 96-well plates or equivalent columns. Water-immiscible solvents: MTBE, EtOAc, hexane, DCM and DCM/IPA (95/5, v/v) were evaluated for cannabis and multi-panel drugs of abuse extraction. Final extracts were evaporated at 40 °C and reconstituted in respective mobile phases. UHPLC-MS/MS analysis was performed using a Shimadzu Nexera UHPLC system coupled to an 8060 triple quadrupole mass spectrometer.

Results
Due to substantially different limits of quantitation required between cannabis and other drug panels it was deemed necessary to separate analyses. Widely abused drugs comprising; amphetamine type, benzodiazepines and Z-drugs, cocaines, opiates and opioids, fentanyls and buprenorphines were treated separately to the cannabis panel comprising; cannabinol (CBN), cannabidiol (CBD), Tetrahydrocannabinol (THC), 11-Nor-9-carboxy-Δ⁹-tetrahydrocannabinol (THC-COOH), 11-Hydroxy-Δ⁹-tetrahydrocannabinol (THC-OH), Δ9-tetrahydrocannabinolic acid-A (THCAA).
Sample clean-up of the methanolic hair extract was performed using supported liquid extraction. A range of solvents were investigated from a recovery and suppression standpoint. In order to reach SoHT LoQs we compared methanolic extract evaporation and reconstitution prior to extraction with direct extraction of the methanol extract. Typical recoveries were greater than 60% or 80%, for the cannabinoid and extended drug panel respectively. Corresponding RSDs were below 10%. A range of extraction solvents were applicable depending on the exact panel required.

Calibration curves constructed between 0.1-200 pg/mg and 10-1000 pg/mg for the cannabinoid and extended drug panel respectively demonstrated good linearity and coefficients of determination (r2) values greater than 0.99 for all analytes. LoQs were below required SoHT quidelines for both screening and confirmation with THC-COOH performance achieving the low level 0.2 pg/mg levels set out.

Conclusion
This poster demonstrates a simplified workflow for the analysis of a range of drugs of abuse from hair matrix, from sample homogenization, through to extraction, cleanup, evaporation and finally quantitative analysis.


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Rapid UPLC-MS/MS Dried Blood Spot Analysis of Steroid Hormones for Clinical Research

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Poster #27f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Background: Dried Blood Spots (DBS) are an established microsampling technique providing a low-cost approach of collecting, shipping and analyzing samples for clinical research. Ligand-binding assays (LBAs) are often used as the frontline testing methodologies for DBS samples in steroid hormone analysis. Although rapid, the relatively low analytical specificity of the LBAs may necessitate follow-up, using liquid chromatography – tandem mass spectrometry (LC-MS/MS). The challenge is to create a fast, analytically sensitive and selective LC-MS/MS methodology for clinical research.
Methods: Certified androstenedione, 17-OHP, cortisol, 11-deoxycortisol and 21-deoxycortisol reference material purchased from Sigma Aldrich (Poole, UK) were used to create calibrators and QC materials in whole blood; prepared by mixing 50/50 (v/v) red blood cells from BioIVT (West Sussex, UK) and MSG4000 stripped serum from Golden West Biologicals (CA, USA). Blood spots were prepared by adding 50µL whole blood calibrators and QCs to Whatman 903 Protein Saver Blood Spot cards from Sigma Aldrich (Poole, UK) and then left to dry. Two 3mm DBS samples were pre-treated with an internal solution and mixed for 5 minutes. SPE was carried out with a Waters Oasis™ MAX µElution 96-well plate, allowing direct injection of the SPE eluate. Offline automated extraction was performed using a Tecan® Freedom Evo 100. Using an ACQUITY UPLC I-Class system, samples were injected onto a 2.1mm x 50mm CORTECS C18 2.7µm column with pre-column CORTECS C18 2.7µm VanGuard using a water/methanol/ammonium fluoride gradient and quantified with a Xevo™ TQ-S micro mass spectrometer.
Results: The method enabled rapid separation in 1.4 minutes (2.3 minutes injection to injection) for 17-OHP, androstenedione, cortisol, 11-deoxycortisol and 21-deoxycortisol with baseline resolution of steroid isobars. Calibration lines were linear from 0.5 – 500 ng/mL for androstenedione and 11-deoxycortisol; and 1.0 – 500 ng/mL for cortisol, 17-OHP and 21-deoxycortisol with correlation coefficients (r2) >0.99 over five occasions. Coefficients of variation (CV) for total precision and repeatability over five occasions at four concentrations; 2, 5, 50 and 400ng/mL, were ≤ 9.3% (n = 25) with accuracies ranging from 94 – 110%.
Conclusions: The challenge was met by using Ultra Performance Liquid Chromatography (UPLC™) combined with CORTECS™ 2.7µm particle columns to provide UPLC separations at high linear velocities with minimal loss in column performance. This offline automated method demonstrates excellent linearity, analytical sensitivity, precision and accuracy, while providing high sample throughput capabilities for the analysis of androstenedione, 17-OHP, cortisol, 11-deoxycortisol and 21-deoxycortisol in dried blood spots for clinical research purposes.
For Research Use Only, Not for use in diagnostic procedures.


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Development and Comparison of Two High-throughput LC-MS Methods for the Accurate Quantitation of IGF1 in Human Serum

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Poster #25c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction:
To achieve a high level of analytical quality for IGF1, we developed a Certified Reference Material (CRM) standard which is traceable to the SI and a full-length stable-isotope labeled (SIL) internal standard. Early introduction of SIL-IGF1 mitigates any source of variation throughout the analytical workflow. Subsequent to reagent development, two high-throughput plate-based LC-MRM formats for accurate quantification of IGF1 were developed. The first workflow incorporates protein precipitation followed by the analysis of intact IGF1. The second workflow utilizes immunoaffinity enrichment followed by rapid, in situ trypsin digestion and analysis of a surrogate peptide.
Method:
Two types of sample preparations methods, protein precipitation, and immunoaffinity enrichment were developed for LC-MS-based quantification of IGF1 in human serum. For calibration, recombinant human serum albumin was fortified with varying levels of IGF1 and spiked with SIL-IGF1. For the protein precipitation workflow, 100 µL of each calibrator was precipitated using acetonitrile with 6% acetic acid. The plate was centrifuged and supernatants were transferred to autosampler vials and intact IGF1 was analyzed by LC-MRM. For the immunoaffinity workflow, 20 µL of calibration standards were enriched using anti-human IGF1 capture antibody bound to a Protein A/G plate and digested with trypsin. A resulting tryptic peptide was analyzed by LC-MRM. MultiQuant software was used for data analysis.
Results:
For precipitation method, using 100 µL of serum, a linear calibration curve in a range of 40 ng/mL to 5 µg/mL with CV values of < 20% and accuracies of 90-116% was obtained. For immunoaffinity method, using 20 µL of serum, a linear calibration curve in a range of 20 ng/mL to 5 µg/mL with CV values of < 15% and accuracies of 85-115% was obtained. All samples were prepared in triplicate in 6% rHSA.
Conclusion:
A plate-based immunoaffinity enrichment kit and a protein precipitation workflow were developed to enable high throughput quantification of IGF1 by LC-MRM MS in less than five hours. The 15N SIL-IGF1 Certified Reference Material is an effective internal standard for both methods. Further experiments will be performed using human serum spiked with known amounts of IGF1 as test samples to check for matrix equivalency between 6% rHSA and human serum.


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Mass Spectrometry Studies of Glutathione S Transferase P1 Protein and Gene and 5-Methylcytosine Level in Acute Lymphoblastic Leukemia

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Poster #9c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Abstract
INTRODUCTION: Childhood acute lymphoblastic leukemia (ALL) is considered for more than 30% of childhood cancer per a year throughout the world. The routine ALL diagnosis and prognosis methods are considered of peripheral blood analysis, the bone marrow aspiration and biopsy, flow cytometry and immunophenotyping assays. They rely on well-known compounds and the interpretation of their results are user dependently and in this regard some mistakes can be happened. Meanwhile, there are some evidences that biomarkers based on mass spectrometry (MS) techniques can be considered as well replacement of these clinical diagnosis and prognosis techniques. Some reports confirm the role of Glutathione S Transferase P1 (GST-P1) protein in childhood ALL risk. In addition, previous reports showed the role of epigenetic in ALL. Figuring out epigenetic modifications in their biological context includes several aspects of DNA methylation analysis. MS techniques can determine epigenetic levels and gene region involve to methylation.
METHODS: In the present study, we have monitored the changes in the GST-P1 protein in blood plasma samples of 19 ALL patients at the diagnosis stage and after finishing their first chemotherapy. We used GST-P1 gene-promoter region to show that a ratio between cytosine and 5-methylcytosine DNA content by gas chromatography-mass spectrometry (GC-MS). In addition, the analysis of PCR samples for GST-P1 gene-promoter was done by MALDI-TOF-MS. We performed similar analyses in the children blood sample of same sex and age.
RESULTS: The affinity magnetic sorbent enriched of GST-P1 protein from blood plasma sample without any pretreatment, followed by MALDI-TOF-MS detection. Our results show the significant variation on GST-P1 protein levels compare to normal blood children and diagnosis procedure of ALL due to chemotherapy of ALL patients. The results of GC-MS are sufficient for discovering methylation variation within a selected target region of these patients. Also, a method for DNA methylation analysis that utilizes MALDI-TOF MS analysis of base-specifically cleaved amplification products has been developed to discover the exact sites of methylation.


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GC-MS Determination of Candidate Target Biomarkers for Early Detection of Oesophageal Squamous Cell Cancer

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Poster #17a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction:

Branched chain amino acid metabolism is deregulated in numerous diseases including multiple subtypes of cancer. For both clinical and molecular studies, there is a need for a unified quantitative method for the key metabolite groups in this pathway. This study aimed to test whether gas-chromatography mass spectrometry (GC-MS) could be used for this purpose.

Method:
The twelve targets are branched chain amino acids (BCAA); valine, leucine and isoleucine, branched chain ketoacids (BCKA); ketomethylvalerate, ketoisocaproate and ketoisovalerate, branched chain fatty acids (BCFA); isovaleric acid, isobutyric acid and 2-methyl butanoic acid, glutamine , glutamic acid and α-ketoglurate. Several sample clean-up, derivatization reagents, column set-ups and oven temperature gradients are compared and optimised.

Results and discussion:

Stock solutions of target compounds where polar compounds are dissolved in deionised water and non-polar compounds in MTBE are made. Saliva samples are collected with an absorptive matrix. Cell media, supernatant and saliva samples are stored at -80oC till analysis. Polar and non-polar compounds are extracted from samples by drying under nitrogen stream and liquid-liquid extraction (LLE) with MTBE respectively. The dried samples are reconstituted with LLE extract. A previous method that utilised chiral derivatisation for BCAA, and methyl esterification for BCKA and BCFA yielded poor reproducibility and high limits of detection (LOD). Hence a silylation method for derivatisation is chosen. Derivatisation is optimised by deciding on the most suitable derivatiser; MTBSTFA and MTSTFA. MTBSTFA derivatisation yield better identification of isomeric peaks on comparison with MSTFA. Further optimisation of temperature, length of incubation time and amount of derivatiser is complete. To obtain the best chromatographic separation of target compounds, three columns, 20mx0.18mm ID x0.18μm d Agilent DB-5ms column, 30mx0.25mm ID x0.25μm d Agilent HP-5ms column and 30mx0.25mm ID x0.25μm d Agilent DB-17ms column are used to run the samples. The best results are achieved with DB-5ms column. The optimum temperature programme is an initial starting temperature of 60oC, ramp to 100OC at 23.5oC/minute with a 9.65 minute hold and a final ramp to 300oC at 40oC/minute and 5 minute hold. Selected ion mode is then generated. The 12 target compounds can be reproducibility determined with low limits of detection.

Conclusion:
This proposed method demonstrates the ability for high throughput, streamlined sample preparation and analysis for candidate biomarkers with GC-MS for use in liquid phase matrices; saliva and cell media. Our results demonstrate high reproducibility, accuracy and sensitivity in a range of matrices, therefore demonstrating that this GC-MS technique can be applied to identifying candidate biomarkers in OSCC.


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LC-MS/MS Measurement of Phosphatidylethanol (PEth 16:0/18:1) and Drugs of Abuse Applying Volumetric DBS Device

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Poster #23f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
Reliable biomarkers have great significance in the investigation of alcohol consumption patterns and in the treatment of alcohol-induced diseases. Conventional alcohol tests are based on the measurement of indirect biomarkers (GGT,CDT etc.) to determine the toxic effect caused by alcohol consumption. However, these indirect biomarkers are not specific enough since they are also affected by physiological and pathological conditions. Direct biomarkers to detect alcohol intake are non-oxidative products of ethanol metabolism. EtG and EtS are conjugated metabolites of ethanol and have narrow detection windows in biofluids. Additionally, severe clinical errors in results may occur stemmed from post-sampling process, either due to storage circumstances or medical conditions of the person being sampled. Phosphatidylethanol (PEth), blood-based direct alcohol biomarker, represents a group of unnatural phospholipids formed on leukocytes and predominantly erythrocyte membranes. Studies demonstrate that the most dominant of these possible forms is PEth-16:0 18:1 consisting of a palmitic and an oleic acid. Moreover, detecting drugs of abuse (DOA) including opiates, amphetamines, cocaine metabolites, benzodiazepines, THC-metabolites etc. is important to establish patterns of illicit drug usage. In recent years, DBS has been gaining interest in plenty of research areas owing to ease of specimen collection and storage. To overcome challenges coming from blood viscosity, volumetric DBS devices have begun powerful alternative for specific volume of blood collection.

Objectives
The main objective of this study was to determine the concentration of PEth-16:0 18:1 in DBS samples collected using a volumetric DBS device (HemaxisTM DB) and to identify/quantify drugs of abuse (including 119 parameters-Jasem Clinical Toxicology mixture) using another blood spot punch of the same DBS sample.

Methods
According to Jasem method, DBS samples were prepared by sampling from spiked 20 µL of blood drop located onto paraffin film. PEth-16:0 18:1 and DOA were extracted from entire blood spot of DBS specimens implementing two different extraction reagents at room temperature for 10 min then subjected to HPLC system equipped with Agilent 6470 triple quadrupole mass spectrometer. The total run times from injection to injection for PEth and DOA were 4.0 min and 12.0 min respectively.

Results
The linearity and accuracy of the methods were evaluated using 5 DBS calibrators levels for PEth and 6 for DOA. Linearity was confirmed in the range 10 to 1000 ng/mL (r²>0.995) for PEth 16:0/18:1 and in the range 2 to 100 ng/mL for DOA (r²>0.99). According to our results, PEth RSD was %5.61 and DOA RSD values were between %1.34-11.73.

Conclusion
Both of Jasem LC-MS/MS approaches are centered on simple sample preparation following non-invasive sample collection method. Prior to rapid extraction, applying volumetric DBS device assures to collect fixed volume of blood.


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Matrix Dilemmas in LC-MS/MS: The Use of Appropriate Calibrators and Internal Standards to Facilitate Acceptable Criteria for Quantification

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Poster #24c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be presented and discussed on Wednesday at 13:00 for 15 minutes in De Anza 2 (right outside Exhibit Hall doors across from Ionpath in Booth 36).

INTRODUCTION: The current method of choice for the clinical investigation of analytes in biological matrices is LC coupled to tandem mass spectrometer via electrospray ionization based on the high selectivity and sensitivity it offers. One of the major obstacles with this analytical method is matrix effects, where the ionization of the compounds of interest are altered by co-extracting and co-eluting matrix components. Many mitigation strategies exist on overcoming matrix effects. One of these strategies is the use matrix-matching calibrators, where the matrix of the biological sample and that of the calibration range are the same or similar. Compensation occurs assuming that the calibrator and sample are influenced by matrix components in the same manner. For the analysis of a complex matrix such as urine, where the dilution range is extensive and matrix components are sample specific, finding a matching matrix is challenging.
METHODS: Our recent investigation in the quantitative LC-MS/MS assessment of urinary GAGs (glycosaminoglycans) again emphasized the challenge in choosing a stable matrix. Three calibrator matrix substitutes containing three commercially obtained GAGs, were selected and compared.
RESULTS: Synthetic urine, saline and water’s suitability is being assessed with the analysis of external quality control material and recovery experiments. An additional mitigation strategy for overcoming matrix effects is the use of isotopically labeled internal standards. The lack of the commercial availability of such internal standards prompted the in-house preparation of them.
CONCLUSION: Combating matrix effect by use of a stable calibrator matrix and isotopically labeled internal standards remains under investigation for this study.


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Untargeted Metabolomic Profiling of Plasma Samples of Patients with MBOAT7 Gene Defect

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Poster #27d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Inborn errors of metabolism related to biosynthesis and remodelling of phospholipids, sphingolipids is a newly emerging area in inherited metabolic disorders. Phospholipids are synthesized by a de-novo process, known as ‘‘Kennedy pathway’’ and are then dispersed asymmetrically by a remodeling process called ''Lands Cycle''.The MBOAT7, subject of the current study, is located in the Lands lipid remodeling pathway and inserts arachidonic acid to the sn-2 position of lysophosphotidylinositol. While there animal models of the MBOAT7 exist to elucidate its functional role, no study has yet been conducted on the effects of the MBOAT7 gene defect in humans.

OBJECTIVES: The goal this study was to explore the plasma metabolome profile of 12 patients with MBOAT7 gene mutation by mass spectrometry to explore the pathophysiological effects of the MBOAT7 gene defect and identify putative biomarkers.

METHODS: Plasma samples from 12 patients whose MBOAT7 gene defect was confirmed by exome sequencing and of 10 healthy individuals were obtained by following the Hacettepe University Rare Disease Biobank regulations by approval from the Hacettepe University Ethical Review Board. Plasma samples are then extracted and profiled by an Agilent Q-TOF-MS system equipped with 1260 HPLC by using InfinityLab Poroshell 120 RP column in both polarities. The resulting data are then uploaded to XCMS Online and MetaboAnalyst for filtering and data processing. Pooled plasma samples (n=5) were analyzed to calculate the coefficient of variation (CV). Masses whose abundance was not reproducible for all biological replicates, as indicated by a relative standard deviation (RSD) larger than 30 % in QC samples, were discarded.

RESULTS: We have found very significant changes in leukotriene metabolites, bile acids, stereate biosynthesis, and mevalonate pathways. Of note, leukotriene A4 and (5S)-HPETE increase by 4 fold (with p<8.5e-8, 8.4e-11 respectively). Arachidonate decrease by 2.4 and 18R-hydroxy-eicosapentaenoate increase by 4.7 fold. (p< 6.3e-12, 7.5e-7 respectively). The most important common feature of these pathways is their involvement as donors in the lipid remodeling pathway. The identified metabolites mighy give new insights into the pathophysiological changes and molecular mechanisms of the disease.

CONCLUSION: This is the first plasma metabolomics study of the MBOAT7 gene defect in humans. We have shown that patients with MBOAT7 gene defect cannot use arachidonic acid as a donor in lipid modeling and it is metabolized through the conversion of leukotrienes and the lipoxin pathway. We are further investigating the metabolites involved in the identified pathways to explore if they can be considered as valuable biomarkers.







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Single-Shot Targeted Proteomics Flavivirus Assay

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Poster #18a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: With pandemic emergence and increasing magnitude of flavivirus outbreaks in recent years, there is an urgent need in the development of a robust diagnostic tool for flavivirus diagnosis and typing to better facilitate disease management, surveillance and control.
OBJECTIVE: The objective of this work was to develop a highly sensitive shotgun diagnostic assay that has typing capability to cover a wide panel of flaviviruses and circumvents the shortcomings of current flavivirus diagnostics assays.
METHODS: Peptides derived from virus and serotype-specific non-structural protein 1 (NS1) were selected as virus/type identifiers to be monitored by targeted proteomics-based parallel reaction monitoring (PRM) approach. This assay was validated using clinical and infected secretome samples.
RESULTS: The assay was shown to confidently distinguish Dengue serotypes (1-4), Zika, Yellow Fever and Kunjin viruses. The ability to diagnose multiple flaviviruses and types over a longer diagnostic window (up to 8 days) with high sensitivity (70% vs 50% by PCR), specificity (100%) and multiplexing capability (7 viruses/types in a single run) in comparison to conventional assays were shown. This assay performs equally well for primary, secondary and co-infections.
CONCLUSIONS: Our flavivirus PRM assay, which can be easily extendable to detect a wider panel of flaviviruses, is the first single-shot flavivirus assay and has addressed the shortcomings of current diagnostics, positioning it to hold high promise as a future flavivirus diagnostic tool.
Reference: Wee et al (2019. Multiplex targeted mass spectrometry assay for one-shot flavivirus diagnosis. Proc Natl Acad Sci U S A. 116:6754-6759


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Developing a New Diagnostic Tool for Small Intestinal Bacterial Overgrowth following Upper-Gastrointestinal Surgery

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Poster #5a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: Nowadays, surgical treatments for oesophageal and gastric cancer, as well as morbid obesity, are increasingly common and have improved patient life expectancy. However, upper gastro-intestinal (GI) post-operative patients frequently experience a long-term decline of quality of life, manifested by symptoms that have often been associated with small intestinal bacterial overgrowth (SIBO); an increase or change of bacterial population in the gut. The current diagnostic tool used in clinic, hydrogen breath test (HBT), measures the change of concentration of hydrogen in the breath after ingestion of glucose. However, this test has a limited specificity. To alleviate this gap, the quantification of certain volatile organic compounds (VOCs) in the breath can be used to identify SIBO.

Objectives: The primary aim of this study was to identify significant VOCs found in the breath of upper-GI post-operative patients correlated with SIBO, to ultimately develop a new diagnostic tool based on the breath profiles of patients.

Methods: Breath samples were collected from 30 patients who had undergone upper-GI surgeries using Nalophan bags and analysed by selected ion flow tube mass spectrometry (SIFT-MS). This online quantification instrument has the ability to immediately calculate the concentration of the trace gas compounds present in breath by using its in-built library. A glucose HBT test was conducted in all patients in accordance to the NHS guidelines together with breath test. 11 targeted VOCs were compared between HBT positive and negative patients using mixed model statistics.
Results: This study has shown that three VOCs, acetone (p-value 0.030), heptanone (p-value 0.012) and butanoic acid (p-value 0.013), were significantly different between SIBO positive and negative patients and, could potentially be used to correctly identify SIBO. These compounds were found to be the product of bacterial fermentation of carbohydrates into fatty acids, indicating a link between SIBO and associated metabolic pathways. Moreover, our data highlighted the lack of clinical characterisation of SIBO and the symptomatic variability seen between post-operative patients.

Conclusion: To conclude, SIBO is a serious clinical concern among post-operative patients. In fact, the prevalence of SIBO determined in our study was quite high (66.7%), often contributing to the decline of quality of life after surgery. In order to improve prompt treatment, breath tests using VOCs seem to be a promising, efficient and non-invasive method of diagnosis.


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Implementation of Lipidomics in the Clinical Routine: Can Fluoride/Citrate Blood Sampling Tubes Improve Preanalytic Stability?

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Poster #3a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION
Lipid compounds are of great interest as potential biomarkers for several diseases. Discovering biomarkers is very challenging since their suitability must be validated, requiring not only robust analytical procedures but also ensuring the quality of the whole analytical process from sampling to data analysis. In particular, the impact of preanalytical sample handling on analyte stability is a rarely described but very important parameter in analyzing any endogenous compound.

OBJECTIVE
The primary objective of the study was assessing the preanalytical stability of several lipid mediators in human whole blood or plasma samples under different sampling and storage conditions.

METHODS
Whole blood and plasma samples of healthy volunteers where incubated at room temperature as well as in ice water for different periods of time ranging from 20 minutes to 24 hours. The impact of two different anticoagulants, K3EDTA and sodium fluoride/citrate, on lipid stability under these conditions was evaluated. The concentrations of several lipid mediators were determined via targeted LC-MS/MS quantification complemented by a non-targeted lipidomics screening using LC-QTOFMS.

RESULTS
The results show that concentrations for several endogenous lipids vary when whole blood and plasma samples are processed at room temperature, whereas most lipids were stable for 4h in ice water. Surprisingly, the concentrations of the endocannabinoids 2-arachidonoyl glycerol (2-AG) and arachidonoyl ethanolamide (AEA) increased in K3EDTA whole blood after storage in ice water for only 20 min. Concentrations after 20 min were 0.715 ± 0.11 ng/mL for 2-AG (t0 = 0.368 ± 0.117 ng/mL)and 0.255 ± 0.047 ng/mL for AEA (t0 = 0.195 ± 0.058 ng/mL). When using sodium fluoride/citrate blood collection tubes, this concentration increase could be prevented and furthermore, the stability of several other lipids was improved as well.

CONCLUSION
Based on the results presented here it is concluded that for endocannabinoid measurement it is absolutely necessary to keep blood sampling and plasma processing time under one hour to avoid ex-vivo formation of these analytes. It is worth mentioning that the baseline lipid levels differ for K3EDTA and sodium fluoride/citrate blood sampling tubes, which emphasizes the importance of traceability of reported plasma concentrations to the used anticoagulant. All in all, the results make clear that several obstacles have to be considered before the proposal of a lipid (mediator) as a potential biomarker for the clinical practice.


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Reversed-phase UPLC-MS/MS Analysis of Plasma Catecholamines and Metanephrines for Clinical Research

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Poster #28g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Background: Analysis of plasma catecholamines and metanephrines for clinical research is challenging due to their low concentrations (pg/mL) and the extreme polar nature of the analytes. HILIC LC-MS/MS has been used successfully but can be challenging to implement. To address this issue, we have developed a reversed-phase UPLC-MS/MS method that employs a previously developed mixed-mode SPE procedure and combines it with reversed-phase chromatography using the Waters UPLC™ HSS-PFP column.

Methods: Plasma samples (250 µL) were loaded onto Waters Oasis™ WCX µElution plates and diluted 1:1 with 50 mM NH4COOH containing 1 ng/mL internal standards. After loading, samples were washed with 200 µL of 50 mM NH4COOH and methanol (MeOH) and eluted with MeOH containing 2% formic acid (FA). After evaporation (5 min.) samples were reconstituted in 50 µL of 97:2:1 Water:ACN:FA, resulting in a 5X sample concentration. Separation was achieved using a Waters ACQUITY UPLC™ HSS-PFP column. All analytes were analyzed using quantifier and qualifier MRM transitions with deuterated internal standards on a Waters Xevo TQ-S micro mass spectrometer.

Results: The method enabled rapid separation in 1.5 minutes (3.5 minutes injection to injection) for norepinephrine (NE), epinephrine (EP), normetanephrine (NMT), dopamine (DA), metanephrine (MTN), and 3-methoxytyramine (3-MT). SPE recovery was consistent and removed phospholipids. Analyte recoveries from 5 plasma lots had %CVs <20% with matrix effects also <20% for all analytes. Calibration curves were linear from 2 – 20,000 pg/mL for all compounds with correlation coefficients (r2) >0.999 over five occasions. Accuracy was within 10% bias and precision was under 12% across all 4 QC levels (15, 30, 750, and 15,000 pg/mL). The method was analytically sensitive, with LLOQs of 10, 5, 5, 5, 2, and 1 pg/mL for NE, EP, NMT, DA, MTN, and 3-MT, respectively.

Conclusions: The challenge was met by using Oasis mixed-mode SPE combined with UPLC separation on the HSS-PFP column and detection by the Xevo TQ-S micro UPLC-MS/MS system. The method demonstrates excellent linearity, analytical sensitivity, precision and accuracy, while providing high sample throughput capabilities for the analysis of plasma catecholamines and metanephrines for clinical research purposes.

For Research Use Only, Not for use in diagnostic procedures.


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Pyroglutamation of Amyloid-β-42 (Aβ1-42) Followed by Aβ1-40 Deposition Underlies Plaque Polymorphism in Progressing Alzheimer’s Disease Pathology

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Poster #4d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction:
Amyloidogenic aggregation of beta-amyloid (Abeta) peptides into senile deposits is the major pathological hallmark of Alzheimer’s disease (AD). The exact mechanisms of AD remain unclear though plaque pathology has been identified as critical. However, Abeta plaques have been found in cognitively unaffected patients that are amyloid positve (CUAP). However, Aβ plaques present in CUAP are mostly diffuse, while plaques in AD brain are mostly mature/compact. Diffuse plaques can therefore represent an immature non-toxic state of mature compact amyloid plaques.

Objective:
As the factors that promote neurotoxic plaque formation are still unknown, changes in Abeta peptide truncation have been implicated with proteopathic mechanisms in AD.
Therefore, a chemical imaging that allows the efficient discrimination of structural and molecular plaque architecture is of essential interest to resolve Aβ plaque pathology in AD.

Methods;
To delineate plaque pathology a novel, multimodal chemical imaging paradigm based on MALDI imaging mass spectrometry in combination with fluorescent probes and immunohistochemistry was developed.Here MALDI IMS on brain tissue was combined with fluorescent amyloid staining using luminescent conjugated oligothiophene probes that recognize structural characteristics of Aβ aggregation dynamics. This technology was applied to probe amyloid polymorphism in human post mortem brain from AD and CUAP individuals as well as in transgenic AD mice.

Results:
The data on in human and mouse tissue show both a significant increase of Aβ1-40 in senile, neurotoxic plaques as compared to plaques of diffuse, pre-amyloid morphology, where no Aβ1-40 was observed both in human AD as well as CUAP. Additional data in mice show that this increase in Aβ1-40 was associated with plaque maturation over time, where both senile plaques and cerebrovascular deposits at 18 months contained higher Aβ1-40/1-42 levels than at 12 months. Further, pyroglutamation of Abeta 3-42 (3pE-42) was found increased only in AD plaques.

Discussion and Conclusion:
A proportionally higher Aβ1-42 content appears therefore to be characteristic for pre-mature deposits and 3pE truncation specific to AD pathology. This suggests diffuse plaques to be precursors of senile plaques and that maturation into senile plaques is associated with AD.pathogenesis involving hydrophobic functionalization through N-terminal pyroglutamation of Abeta 1-42 followed by deposition of more soluble Abeta 1-40.
Taken together, the here presented hyperspectral chemical imaging paradigm of individual, chemically and structurally delineated Aβ deposits provides insight in the chemical aspects underlying evolving plaque pathology in AD that is not facilitated by other biochemical techniques.


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Improvement of the Experimental and Informatic Pipeline for High-Throughput MS/MS Proteotyping of Pathogens

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Poster #11f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Quick identification of pathogens is crucial for efficiently fighting against infectious diseases. Mass spectrometry is a powerful and discriminative tool for this. Whole-cell MALDI-TOF is successful for most pathogens but requires a pure sample usually obtained after cultivation. Tandem mass spectrometry proteotyping has been shown to be an interesting alternative for complex samples and could avoid the cultivation step.
OBJECTIVES: Here, we present an optimization of the sample preparation for MS/MS proteotyping of any type of microorganisms, as well as an optimization of the data treatment for a fast result.
METHODS: We proposed a bead-beating extraction of proteins and tested several protocols for fast trypsin proteolysis. A protocol based on magnetic beads was selected and further improved in order to achieve automatization of the sample preparation in 96-well plates. The bioinformatics pipeline for high-throughput MS/MS proteotyping was also optimized. The whole workflow is adapted for the identification of pathogens of clinical interest.
RESULTS: The optimized sample preparation method based on magnetic beads could be routinely performed in less than 1 h. The protocol was tested on an artificial mixture comprising Gram-positive and Gram-negative bacteria, as well as yeasts. We obtained perfect MS/MS proteotyping of several pathogenic strains. The optimized workflow enables to get an accurate identification of pathogen within 3 h after receiving the clinical sample, even if the sample is a mixture of microorganisms or in presence of MALDI-TOF incompatible matrix. Results show that even subtyping is possible with the same workflow. It is applicable to hundreds of samples treated in 96-well plates.
CONCLUSION: The results presented in this study illustrate the power of the approach, which addresses without a priori any kind of isolates, but also more complex samples such as mixtures of organisms.


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Validation of a LCMS Assay for Citrulline Suitable for Daily Routine Through an Original MRM Approach

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Poster #21f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

OBJECTIVES:
Citrulline is a nonproteinogenic amino acid synthesized from glutamine by enterocytes of the small intestine, considered as a functional marker of the enterocyte mass. We aimed to evaluate the analytical and clinical performances of an UPLC-MS method within a cohort of patients with acute abdomen, including patients with acute mesenteric ischemia (AMI).

DESIGN & METHODS:
Citrulline was measured after protein precipitation on Ostro™ Plates by UPLC-MS on a Xevo-TQS (Waters) on a BEH Column. We evaluated the analytical performances according to the CLSI EP10-A3E. We evaluated precision, linearity, carry-over, and matrix interference.
We integrated the sample composition in the development of the method through MRM and chromatographic separation of Phospholipids (PL), Triglycerides (TG) and Bilirubin. We admixed plasma samples of increasing concentrations of TG, Bilirubin to low and high quality controls (QC). Citrulline was measured in eighty patients samples with acute abdominal pain, including 40 patients with AMI.

RESULTS:
Intraday imprecision was lower than 8% for low and high QC samples of citrulline (12.4 and 62.4 µmol/L, N=30). The linearity ranged from 0.5 and 120 μmol/L compatible with the reference values previously published. The low limit of quantification was at 0.1 µmol/L with a CV of 5 % and the upper limit of quantification superior to 500 µmol/L with a CV < 1%.
The carry over performed by mixing low and high QC (10 and 60 µmol/L respectively) was acceptable with a negative 7% bias at 10 µmol/L.
For the matrix interference study, we confirmed the removal by the Ostro plate of both PL and lysoPL. For the sample composition study, we calculated the bias on low high QC (n=3) mixed with plasma samples with increasing concentration of bilirubin (82-320 µmol/L) and TG (5-20 mmol/L).
For the bilirubin interference, the bias for the low QC ranged from -1.4 to 8.6%, and for the high QC, from 1.8 to 11.7%.For the TG interference the bias for the low QC low ranged from 18.5 to -27%, and for the high QC from 7.9 to 10.2%.
We obtained results for 40 patients with AMI and 40 patients with abdominal acute pain. Median of citrulline in AMI patients was 16.2 µmol/L (IQ: 12.3-29.8) compared to 23.1 µmol/L (IQ: 19.4-29.6) in other etiologies.
CONCLUSION:
Hence we present a robust method for everyday clinical practice based on an original MRM approach for citrulline measurement that presents promising results in patients with AMI.



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Developing the Research to Routine Workflows with FAIMS: Automating Large-Scale SRM Method Creation for Routine Plasma Proteomics Screening

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Poster #11d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.


Introduction:
Highly multiplexed protein panels are developed to enable routine sample screening while maintaining high throughput. The challenge to creating an analytically robust SRM method is determining which peptides to select per protein and creating the resulting SRM table for confident data acquisition. Each protein added to the target list increases total SRM count by 9 quickly causing acquisition challenges on triple quadrupole mass spectrometers as most proteotypic peptides cluster into small hydrophobicity groups. To increase the selectivity space, we have incorporated a field asymmetric waveform ion mobility spectrometry (FAIMS) interface for both profiling and screening to increase the selectivity metrics for an SRM method monitoring over 300 plasma proteins in 60 minutes.

Experiment:
A stock solution of tryptic plasma digest was used for all experiments. Plasma profiling was performed using an Orbitrap tribrid mass spectrometer with a FAIMS interface. A total of 2 µg of the plasma digest was injected and analyzed using a single compensation voltage (CV) setting by standard DDA methods and repeated for eight different CV settings. Each RAW file was processed to create a data matrix of proteins and peptides, retention time, CV, and precursor and product ion distribution profiles. A routine was created to construct a scheduled SRM table for the top 300 plasma proteins using over 2500 SRM transitions. The SRM table was imported into a triple quadrupole mass spectrometer with the FAIMS interface and evaluated for analytical performance.

Preliminary Data:
The discovery method was used to fully characterize the non-depleted plasma digest. Replicate sample injections using single CV settings significantly increases the protein coverage from 310 proteins without FAIMS to over 500 proteins with FAIMS. In addition, the resulting data is used to create a four-dimensional library that consists of the protein and corresponding peptides, and for each peptide, the measured retention time, CV setting, and optimal precursor m/z value and product ion distribution is recorded. The addition of FAIMS enhances the selectivity and sensitivity of peptides increasing the number of available peptides per targeted protein resulting in more options to be considered in creating the scheduled SRM table.
For the different protein groups targeted, the optimal peptides were selected based on relative response in the discovery method, but more importantly on the retention time and CV setting as the two values were used to create the final SRM table. Peptides were groups into overlapping retention time and CV bins to maximize duty cycle while maintaining analytical performance. Initial results for the 100 and 200 targeted protein tables result in over 85% and 80% for the peptides maintaining acceptable quantitation ion ratio calculations. The peptide selection process was reevaluated prior to moving on to the 300 targeted protein list.


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Detection of Carbapenemase-producing Organisms via MALDI-TOF

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Poster #19c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION:
Carbapenem antibiotics have been considered to be the last resort for the treatment of life threatening infections. Carbapenemases are enzymes which inhibit most β-lactam antibiotics, including carbapenems and they have been reported in Enterobacteriaceae, P. aeruginosa, and others. The emergence of carbapenem-resistant enterobacteriaceae(CRE) poses major threat to public health. Among carbapenem-resistant enterobacteriaceae, some of them carry resistance determinants in motile genetic elements and they are capable of transferring the resistance to other microorganisms. Hence, they are called carbapenemase-producing enterobacteriaceae(CPE) .
When CRE is detected from a patient, it is important to rapidly detect whether the resistant orgranism can be spread to others. Recently, MALDI-TOF MS has been adopted as a universal tool for the identification of microorganism and several attempts have been made to use this technology beyond the identification to more complicated characterization of microorganism.
In this study, we used a MALDI-TOF MS based approach for the detection of specific peak which can be helpful for the differentiation of CPE from other CRE.
METHODS:
The cohort was composed of 51 CRE clinical isolates collected from patients between December 2016 and October 2018 at the Kyungpook National University Hospital. Among the clinical isolates, 39 samples had CPE mobile elements which were confirmed by PCR. Among those, four samples had NDM-5 and 29 samples had both NDM-5 and OXA-181. Proteins were obtained with the tube extraction method and MALDI-TOF MS spectra were obtained. Using MALDIquant R program, mass spectra were analyzed to find any peak difference between CPE negative microorganism and CPE positive microorganism.
RESULTS:
When control samples(ATCC E. coli) and NDM5 CPE samples were compared, m/z  9744.45 Da were found to be the most differentiating peak. When control samples(ATCC E.coli) and CPE which has NDM 5 and OXA181 compared, m/z  3022.34 Da were found to be the most differentiating peak. Further study for the confirmation of the peaks is in need.

CONCLUSION:
Application of MALDI-TOF MS for the rapid detection of CPE is a cheap, reliable, and clinically useful method and will be very helpful for prompt control of infections caused by CRE.


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Prednisone and Prednisolone Detection in Urine Samples: A GC-C-IRMS Method to Discriminate Exogenous or Endogenous Origin

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Poster #16a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: Prednisolone and its prodrug, prednisone, are two glucocorticoids banned “in competition” by the World Anti-Doping Agency (WADA) when administered by intravenous, intramuscular or rectal routes. They could be found in human urine even if no exogenous administration occurred, because of an ex vivo Δ1-steroid-hydrogenation of cortisol and cortisone physiologically excreted in urine. WADA has established that an additional confirmatory analysis should be performed on samples in which the prednisone and prednisolone concentrations are between 30 and 60 ng/mL to discriminate their exogenous origin from the ex vivo endogenous one.
Objective: A new method based on gas chromatography coupled to carbon isotope ratio mass spectrometry (GC-C-IRMS) was developed and fully validated.
Method: Urine samples (max volume: 25 mL) were processed without any derivatization or chemical structure modification according to the method routinely used in our laboratory for the confirmation analysis of pseudo-endogenous steroids. Two LC purification steps were developed before the GC-C-IRMS instrumental analysis to remove potential interferences in the determination of the δ13C (‰) values. Tetrahydro-11-deoxycortisol (THS), pregnanediol (PD) and pregnanetriol (PT) were selected as endogenous reference compounds (ERCs). Two different GC methods were implemented to guarantee an adequate sensitivity for each compound. Linearity, selectivity, limit of quantification (LOQ), recovery, repeatability and measurement uncertainties were evaluated. Sixteen different prednisone and prednisolone pharmaceutical formulations commercially available in Europe were analysed to determine their carbon isotope composition. The method was assessed to be fit for purpose by the analysis of urine samples from excretion studies on healthy volunteers.
Results: Prednisone showed a linear response (r2 = 0.999) within 300 to 3200 mV and a δ13C (‰) average value of -28.94 ± 0.33 ‰, whereas prednisolone exhibited a linear response (r2 = 0.997) between 250 and 2860 mV and a δ13C (‰) average value of -28.70 ± 0.27 ‰. In both methods, no interfering peaks were detected at the expected retention time of the two target compounds and the LOQ was established at 20 ng/mL. The δ13C (‰) of samples deviated less than 0.5 ‰ from the reference materials delta values. The uncertainty of the method was estimated at 0.3 ‰ for both compounds. All the pharmaceutical formulations showed typically exogenous δ13C (‰) values, except for one Belgian product (-16.26 ± 0.24 ‰). The δ13C (‰) values obtained from the excretion studies agreed with those previously determined from the pharmaceutical preparations.
Conclusions: The set-up conditions allowed to obtain reproducible and reliable delta values within the linearity range down to the concentration of 20 ng/mL. The method can be applied, as required by WADA, to identify the exogenous or the ex vivo origin of prednisone and prednisolone.


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The Effect of Sample Tube Type, pH, Storage Time and Temperature on Antihypertensive Non-Adherence Results by Quantitative LC-MS/MS

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Poster #1a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Background
Hypertension is a global health epidemic, and is the leading cause of disease morbidity and mortality in the world. Non-adherence to hypertension medication is a common problem; around 25% of patients show some degree of non-adherence. Biochemical testing has been developed to diagnose non adherent behaviour. These qualitative screens use liquid chromatography-tandem mass spectrometry (LC-MS/MS), and therefore are the most accurate technique available. However, the effects of pre-analytical factors have been suggested to lead to false negative results. The aim of this study was to investigate the impact of these pre-analytical factors on detection of antihypertensive drugs in urine.
Method
Validation
Six antihypertensive drugs that are currently being used in the non-adherence screen by the National Centre of Drug Adherence Testing (NCAT) were investigated using the Waters Acquity XEVO TQD LCMS system with an ESI Z-spray triple quadrupole mass spectrometer in positive ion mode. A quantification assay for amlodipine, atenolol, indapamide, losartan, propranolol and verapamil, were then validated. Parameters assessed were: precision, accuracy and recovery, linearity, carryover, selectivity, matrix effect, calibration curve, lower limit of detection (LLOD) and lower limit of quantification (LLOQ).
Stability study
Recovery of medications in a sample of six different containers after varying the pH (4-8), temperature (room temperature and 4˚C) and storage time (three or seven days) were studied.
Results
All validation criteria defined by Center for Drug Evaluation and Research (CDER) were met for each of the drugs. Amlodipine, atenolol and verapamil stabilities were most affected by pre-analytical factors. Overall recoveries ranged from 56.1% to 102.2%. The recoveries of all six drugs significantly decreased from pH 4 to pH 8. Stability at room temperature was higher compared to 4˚C. There was a small drop in recoveries of amlodipine, indapamide and verapamil at seven days vs. three days. Glass containers appear to least effect the sample stability while it was the worst with metal cap containers. Universals also had poor recoveries for each of the drugs. LLOD for each drug was below 10ng/mL with CV% <20.
Conclusion & Discussion
Quantitative LC-MS/MS shows there is an effect of pre-analytical factors on levels of antihypertensive medication detected. In particular for pH and sample tube type. Urinary pH is a non-modifiable pre-analytical factor. Sample tube type will need further investigation to assess whether or not it has an effect on the current qualitative biochemical adherence screen for antihypertensives.


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Measurement of Oestrone and Oestradiol by Liquid-Chromatography Tandem Mass Spectrometry

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Poster #11a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: The two major metabolically active oestrogens in the non-pregnant population are oestrone (E1) and oestradiol (E2). Accurate measurement of E2 at low concentrations is important in a variety of clinical situations including inborn errors of metabolism, disorders of puberty, post-menopausal women, monitoring aromatase inhibitor treatment, and in men. Measuring oestrogens at very low concentrations remains an analytical challenge. Many published methods involve complex and time-consuming sample preparations, large sample volumes and chemical derivatisation. Here we present a simple liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to measure serum E1 and E2 in the low pmol/L range.

Methods: 250 µL of serum was spiked with diluent containing deuterated internal standards (d4-E1 and d5-E2), loaded onto a Biotage ISOLUTE® supported liquid extraction (SLE) 96-well plate and eluted using dichloromethane. This process was automated using the Biotage® Extrahera™. Samples were evaporated to dryness, reconstituted in 50% methanol and injected onto a Waters® Acquity UPLC™ BEH phenyl column. E1 and E2 were separated under isocratic conditions using methanol and water containing 0.02 mM ammonium fluoride with a run time of 3.5 minutes. Detection was performed using the Waters Xevo® TQ-S instrument in negative ion mode with transitions 269>145 (quantifier) and 269>159 (qualifier) for E1 and 271>183 (quantifier) and 271>145 (quantifier) for E2.

Results: The functional limit of detection was 3.7 pmol/L for E1 and 18.5 pmol/L for E2 and the calibration curve was linear up to 2570 pmol/L for both. The intra-assay and inter-assay precision, expressed as percentage CV, was < 15% at 22 pmol/L, 111 pmol/L and 554 pmol/L for E1 and E2. Accuracy was evaluated using BCR®-576 certified reference material (CRM) with a bias of 3.8% for E2. The average recovery for E2 was 105%. The LC-MS/MS E2 assay was compared with an Abbott Architect i2000SR chemiluminescent immunoassay (n=70) with r2 of 0.91.

Conclusions: We have developed and validated a fit for purpose LC-MS/MS assay for the simultaneous measurement of serum E1 and E2 in men, children and menopausal women. The concentration of ammonium fluoride in the aqueous mobile phase was critical in achieving an improved functional limit of detection, and avoidance of an interfering peak. It has high throughput owing to the readily automatable sample extraction and uses a relatively small sample volume with no requirement for chemical derivatisation. This assay offers significant advantages in terms of sensitivity when compared to our current commercial immunoassay. We hope to further improve the functional limit of detection, as recommended in The Endocrine Society position statement, following the purchase of a Waters Xevo® TQ-XS instrument.


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Serum Metabolomics Using LC-MS Reveals Potential Biomarker of Myocardial Ischemia

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Poster #20k View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
Cardiovascular disease (CVD), one of the leading cause of death worldwide, are influenced by a wide range of genetic, dietary, and environmental factors. As CVD is a complex pathophysiological disease, more intensive research is needed to elucidate the diagnostic approach. Metabolomics, a field of omics science that comprehensively analyze low-molecular-weight compounds in biological systems, can be used in patient omics profiling, diagnosis, and monitoring. In the present study, we aimed to identify biomarker candidates for myocardial infarction (MI) using mass spectrometry-based metabolomics.
Methods and Results
We performed metabolomic profiling of serum samples from MI patients (70 MI patients and 70 controls) in a discovery phase using UPLC/Q-TOF MS. And then, we analyzed serum sample (274 MI patients and 273 controls) in independent validation phase using UPLC/TQ MS. In discovery set, serum 11 metabolites, including purines, carnitine, acyl-carnitines, amino acids, taurine, and organic acids, showed significantly dysregulated levels in MI using Mann-Whitney test and ranked ANCOVA adjusted age and sex. Further, inosine and hypoxanthine were discriminated between MI and normal sample (area under the curve (AUC) value > 0.8) in the discovery set. Therefore, we conducted a targeted analysis of metabolites related to purine metabolism in the validation set. Serum concentrations of hypoxanthine, inosine, xanthine, and xanthosine were significantly higher in MI patients compared to the normal sample adjusted age and sex (p<0.001). Also, the diagnostic model of hypoxanthine, which was constructed based on the ROC curve of the MI patients and normal sample, showed the AUCs ranged from 0.8 to 0.864.
Conclusion
The current study demonstrated that hypoxanthine could be used as a biomarker candidate to distinguish MI patients from normal and metabolomics technologies are well suited for identifying biomarkers for CVD and provide value for clinical diagnosis of CVD.


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Implementation of Triple Quadrupole LC-MS/MS Complete Kits on a High Resolution Mass Spectrometer – Limitations and Benefits

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Poster #14a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Over the last decade, liquid chromatography coupled to mass spectrometry (LC-MS) has gained widespread popularity and transitioned from research to routine clinical laboratories. While most clinical research laboratories use triple quadrupole mass spectrometers combined with liquid chromatography (LC-MS/MS), for targeted, selective and sensitive quantitation, an increasing number of laboratories prefer one single MS that can efficiently perform routine quantitation of analytes and also screening, confirm, and characterize unknown analytes (ranging from small to large sizes). As a result we observe increasing demands for ready-to-use complete kits for small molecules running on high resolution instruments.

OBJECTIVES: In this study, we report benefits and limitations faced during implementation of RECIPE ClinMass® LC-MS/MS complete kits on a Thermo ScientificTM Q Exactive PlusTM coupled to a Thermo ScientificTM VanquishTM Duo system for Research Use Only.

METHODS: Different detection modes (FullMS, tSIM, PRM) were tested. A complete verification of all kits was carried out, performance was compared to results from a Thermo ScientificTM EnduraTM coupled to a Thermo ScientificTM TranscendTM II system. We provide results from RECIPE’s MS7000 25-OH-Vitamin D2/D3 kit and MS9000 TDM Platform.

RESULTS AND CONCLUSION: In conclusion, our Q Exactive verification data demonstrated good analytical performance meeting research laboratory requirements.


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Characterizing the Novel Metastatic Regulator in CRPC-based on Quantitative Proteomics

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Poster #27a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Prostate cancer (PCa) is the most commonly diagnosed genital cancer in men worldwide. In 2017, the American Cancer Society reported a large increase in the rate of new PCa cases, accounting for 57% of all new genital cancer cases. Among patients who develop advanced PCa, 80% suffer from bone metastasis, with a sharp drop in survival rate.

OBJECTIVES: Despite much effort, the details of the mechanisms underlying castration-resistant PCa (CRPC) remain unclear. SIRT5, an NAD+-dependent deacylase, is hypothesized to be a key regulator of various cancers, but compared to other SIRTs, the role of SIRT5 in cancer has not been extensively studied.

METHODS: Here we show significantly decreased levels of SIRT5 in PC-3M, a CRPC cell model with increased aggressiveness compared to the parental PC-3 cells, and we confirmed that downregulation of SIRT5 promoted cell migration and invasion. PC-3 and PC-3 SIRT5 KO cells were grown in SILAC media and normal RPMI media, respectively. Using quantitative proteomics analysis, we characterized the differentially expressed proteins (DEPs) between parental and SIRT5 KO PC-3 cells.

RESULTS: We identified 3,699 proteins and quantified 3,073 proteins through the MaxQuant database search program, including 26 down- and 24 up-regulated proteins, respectively. Among up-regulated proteins, we found a substantial increase in interleukin-1b (IL-1b) expression in SIRT5 KO cells, and the PI3K/AKT/NF-kB signaling pathway was found to be significantly elevated in SIRT5 KO cells by GO annotation and KEGG pathway functional enrichment analysis. We also confirmed that SIRT5 can bind PI3K by immunoprecipitation analysis.

CONCLUSION: This study is the first to demonstrate a relationship between SIRT5 and PCa metastasis, suggesting that SIRT5-mediated inhibition of the PI3K/AKT/NF-kB pathway is reduced in CRPC cells.


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Direct Monitoring of Fucosylated Glycopeptides of Alpha-Fetoprotein in Hepatocellular Carcinoma Serum by LC-MS/MS with Immunoprecipitation

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Poster #28d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction: The N-glycosylation of proteins is one of the most important post-translational modifications relevant to various cancers. Among them, alpha-fetoprotein (AFP) is a widely used serological marker that has been associated with hepatocellular carcinoma (HCC). Even though the level of AFP is increased in serum of HCC patients, its diagnostic sensitivity of HCC is poor because AFP levels are also increased in liver diseases, such as cirrhosis. Therefore, various assays for HCC have been developed to increase the sensitivity and selectivity for diagnosis. Above all, changes of fucosylation have been reported to be associated with the development of HCC.

Objectives: We directly monitored fucosylated glycopeptides in AFP to distinguish between HCC and cirrhosis patients by parallel reaction monitoring (PRM) mass spectrometry (MS) combined with immunoprecipitation. We sought to evaluate glycopeptides of AFP as a tool for differentiating between early HCC and cirrhosis.

Methods: First, LC-MS/MS-based PRM combined with immunoprecipitation was performed to analyze glycopeptides. Second, sialic acid was removed enzymatically using a neuraminidase to improve the analytical sensitivity. Finally, tryptic N-glycopeptides were selected to determine the percentages of fucosylated AFP using Y ions, which include glycopeptide fragments with amino acid sequences.

Results: The treatment of neuraminidase to glycopeptides for desialylation was useful to improve MS detection limit (LOD < 2 ng/mL) and to obtain reliable signal (CV < 20%) of target glycopeptides in AFP from sub µL serum. Finally, relative percentage of fucosylated AFP (AFP-fuc%) out of total glycosylated one was applied to compare sera with HCC and liver cirrhosis. AFP-fuc% showed an area under the ROC curve (AUC = 0.949) to discriminate between HCC and cirrhosis patients.

Conclusion: This study provides a promising analytical strategy for direct monitoring of relative percentage of fucosylated glycopeptides without internal standard by combining a LC-PRM with immunoprecipitation. Thus, our method may have wide applications for the verification of glycoprotein biomarkers in blood samples.


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Performance of the Cascadion SM Immunosuppressants Panel on the Cascadion SM Clinical Analyzer

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Poster #23g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION
Sustained immunosuppressive therapy is an essential component for long-term outcome after allografic organ and tissue transplantation. As therapeutic indices of all immunosuppressant drugs (ISDs) are narrow and all substances are subject to significant transversal and longitudinal fluctuations in pharmacokinetics, therapeutic drug monitoring (TDM) is mandatory. Today the quantification of ISDs using LC-MS/MS is the widely-accepted reference method in clinical TDM.

OBJECTIVES
The ISD assay* for Thermo Scientific™ Cascadion™ SM Clinical Analyzer** for the quantification of tacrolimus, sirolimus, everolimus and cyclosporin in whole blood is described in technical detail and data on the analytical performance are presented.

RESULTS
Lower limit of quantification (LLoQ) for Tacrolimus, Sirolimus and Everolimus is 1.0 ng/mL and upper limit of quantification (ULoQ) 30 ng/mL. For Cyclosporine A LLoQ is 10 ng/mL and ULoQ is 800 ng/mL. Linearity (R) of the method for Tacrolimus is 0.999, Sirolimus 0.997, Everolimus 0.999 and Cyclosporine A 1.000. Tacrolimus repeatability varies between 2.8% and 3.4%, Sirolimus between 2.8% and 6.6%, Everolimus between 5.0% and 6.0%, and Cyclosporine between 1.4% and 2.3%. Accuracy of Tacrolimus varies between –9.5% and -5.4%, Sirolimus between -9.3% and -3.2%, Everolimus between 1.7% and 3.5%, and Cyclosporine between -17.7% and -7.7%.

CONCLUSION
The ISD assay for CascadionTM Clinical analyzer provides analytical results from whole blood patient samples without off-line sample pretreatment fulfilling all guideline specifications and proficiency testing requirements.

* ISD assay for Cascadion SM Clinical Analyzer is in development. Product is not IVD/CE marked or 510(k) cleared, and is not available for sale.
** Cascadion SM Clinical Analyzer is IVD/CE marked but not 510(k)-cleared and not yet available for sale in the U.S. Availability of product in each country depends on local regulatory marketing authorization status.


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‘Functional Microbiomics’ – Standardized Assessment of Nutrition-Microbiome-Host Interplay by Targeted Metabolomics

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Poster #15b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
In recent years, microbiome research has dramatically reshaped our understanding of how symbiotic microbes impact on a multitude of (patho-)physiological processes in the host. However, causal links are still lacking to a large extent. Metabolomics allows the investigation of microbial metabolic activities, and is thus the ideal technology to assess functional nutrition-microbiota-host crosstalk. Here, we discuss the application of a newly developed standardized targeted assay for the quantification of endogenous and microbiota-derived metabolites covering central metabolic pathways.

Methods
Human EDTA plasma and fecal homogenate were analyzed by using a standardized, quantitative assay in kit format allowing for the multiplexed analysis of 630 metabolites by mass spectrometry. Liquid chromatography tandem mass spectrometry (LC-MS/MS) was employed for the analysis of 106 small molecules from 13 compound classes, whereas flow-injection analysis tandem mass spectrometry (FIA-MS/MS) was employed for the analysis of hexoses and 523 lipids from 12 lipid classes. A sample volume of 10 µL were used per well on a 96-well plate, preloaded with internal standards. After derivatization and extraction, LC-MS/MS and FIA-MS/MS analyses were performed (Agilent 1290 Infinity UHPLC – SCIEX QTRAP® 5500). MetIDQ™ software was used for the entire automated workflow, from sample registration to quality-controlled, quantitative results.

Results
In plasma, more than 455 metabolites were quantified above LOD with high precision, and more than 120 metabolites in fecal samples. To a large extent, the small molecules and lipids quantified in feces overlap with those in plasma. A higher number of lipids, especially phosphatidylcholines and triglycerides, were quantified in plasma compared to fecal samples. In addition to endogenous metabolites, a multitude of microbiota-derived metabolites were quantified.

Conclusion
The capability to quantify microbiota-derived metabolites in blood and fecal samples allows for correlation studies also with data from other omics technologies to investigate functional nutrition-microbiome-host interplay for uncovering causal links to pathophysiological processes, disease development, and response to drug treatment.


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Brain Tumour Characterization Using Laser Desorption Imaging – Rapid Evaporative Ionisation Mass Spectrometry

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Poster #1b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Brain tumours have a very poor prognosis with 10-year survival currently at 14%. The extent of tumour excision is positively correlated with outcomes, however current neuro-navigation methods offer limited information at the tumour margin. Rapid Evaporative Ionisation Mass Spectrometry (REIMS) coupled with electrosurgery known as Intelligent Knife (iKnife) has been previously shown to provide near real-time tissue characterisation with accuracy, comparable to histopathology in different tumour types. Mass spectrometry imaging (MSI) methods provide the means to detect molecules in a spatially resolved manner and can provide insights into tumour metabolism. Laser Desorption Imaging – Rapid Evaporative Ionisation Mass Spectrometry (LDI-REIMS) is one of such MSI techniques that allow for analysis in ambient conditions.
OBJECTIVES: This study aims to build spatially resolved diagnostic ex vivo models using LDI-REIMS that can potentially be used for in vivo tissue diagnosis with the iKnife, hence potentially improving the extent of tumour resection.
METHODS: Fresh frozen brain tumours including grade IV glioblastoma, meningioma and metastatic tumour (lung adenocarcinoma origin) were obtained from patients (consented for research) following surgical resection. Tumours were sectioned (10 μm), mounted on Superfrost slides (Thermo Fisher Scientific, Waltham, USA) and stored at -80°C prior to analysis. A Xevo G2-S QToF (Waters, Wilmslow UK) mass spectrometer was used in negative mode with an Opolette HE2731 OPO laser (Opotek, Carlsbad, USA) at 2.9µm wavelength for the LDI-REIMS to achieve a 70 μm pixel size. Post analysis, slides were sent for H&E staining and histopathological validation. Data analysis was conducted with multivariate statistical methods including principal components analysis (PCA) and linear discriminant analysis (LDA)
RESULTS: Preliminary results reveal distinct classification of tumours with high accuracy, sensitivity, specificity on cross-validation. In addition, insights into intra-tumour heterogeneity were gained by observing the spatial distribution of different metabolites in parts of the tumours. Next steps include using a spectral identification algorithm based on the ex vivo LDI-REIMS models to characterize a novel sample. Furthermore, co-registration of single ion images with histologically annotated H&E images is also planned.
CONCLUSIONS: Although the sample size is limited, results are promising. Further analysis is warranted as well as expanding the dataset.


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Simultaneous Determination of Antihypertensive Drugs in Serum by LC-MS/MS

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Poster #18b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Antihypertensives (AHT) is a class of drugs that are used to treat hypertension. The compliance to antihypertensive therapy is critical to achieve adequate blood pressure and avoid complications such as stroke or myocardial infarction. Therapeutic drug monitoring (TDM) is a reliable approach to assess AHT compliance, moreover TDM helps to distinguish non-compliance from patients with true resistant hypertension.

OBJECTIVES: The aim of this work, based on the physician’s requests, was to develop, validate and implement method for quantification of 21 AHT in serum samples suitable for use in routine laboratory practice.

METHODS: Methods for quantification of AHT in serum are based on reversed phase liquid chromatography and ESI+ ionization. Sample preparation requires single step of protein precipitation. Methods development and validation were performed on Agilent 6460 Triple Quadrupole LC/MS System. Compounds were separated on an Agilent Poroshell 120 2.7 µm, 2.1 x 100 mm HPLC Column using gradient elution (0.1 % formic acid in water as mobile phase A and methanol or acetonitrile as mobile phase B). For determination of analytical parameters patient samples, commercially available materials (Chromsystems) and inhouse spiked calibrators and controls were used. For quantification of serum concentrations isotopically labeled internal standards were used.

RESULTS: Two LC-MS/MS methods for 14 AHT have been developed and validated so far. The first method is dedicated for 7 analytes – Irbesartan, Losartan, Telmisartan, Valsartan, Amlodipine, Nitrendipine, Indapamide. The second method is dedicated for 7 analytes – Acebutolol, Bisoprolol, Betaxolol, Carvedilol, Atenolol, Nebivolol, Metoprolol. For both methods the intra-assay and inter-assay coefficients of variation (CVs) were below 10 %. Recoveries, determined by standard addition, at normal and pathological concentration levels ranged between ±15 %. Methods provided linearities in the relevant concentration range (5 - 1000 µg/l, for LLOQs CVs were below 10 %. Stability of inhouse prepared calibrators is being tested at different storage conditions, -20 ˚C and -80 ˚C. As far, after 2 months, all analytes are stable and there is no significant difference observed between calibrators stored at -20 ˚C and calibrators stored at -80 ˚C (more data will be collected).

CONCLUSION: Two methods for determination of 14 AHT have been developed so far. The analytical performance of the developed methods is satisfactory. Both methods fulfilled requirements for validation parameters for all analytes. Presented approach with the difference only in mobile phase B and gradients allows for easy and fast changing between methods with minimal manual intervention and provides optimized workflows in daily laboratory routine practice.


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High-Throughput PEAKS Workflow and SPIDER Algorithm for Large Scale Clinical Proteomics and Variant Identification Using PEAKS Online X

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Poster #20m View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

NTRODUCTION: The field of clinical proteomics is rapidly advancing and new mass spectrometry technology as well as streamlined sample preparation workflows are making the use of mass spectrometry in the clinical lab ever more attractive.

METHODS: Large scale clinical projects, whether research or clinical, often require quantitation of thousands of proteins, either by label free (LFQ) or by using isobaric tags such as TMT. PEAKS Online is a new high-throughput protein sequencing software solution that runs on a shared resource, is flexible to scale, and is fully parallelized with the ability to run on any cluster or multi-cluster CPU machine. Herein we describe the use of PEAKS online in analyzing two published data sets; one employing LFQ, and the other employing TMT.

RESULTS: LFQ data with match between runs is notorious for taking a significant amount of time to search. With the new build of PEAKS Online X, we are able to search 28,858,408 MS2 Spectra (56 fractionated samples, 672 180-min Orbitrap MS Runs) in 17h11m with using 512 CPU Cores. For TMT data, we tested a CPTAC Study (Zhang et al, Nature, 2014) to test 155 colorectal cancer samples, each fractionated into 15 samples and run on an Orbitrap-Elite (FT-IT mode) for 180min/fraction. This resulted in 2325 total RAW Files accounting for 6975 total hours of MS acquisition time and 19,983,186 MS2 scans. In total, we identified 145,706 unique peptides and 11,321 protein groups compared to the initial published search of 124,823 and 7,526 peptides and proteins respectively. This was accomplished in under 48 hours of search time.
Finally, in clinical research the ability to identify sequences that are not necessarily in a standard database is critical to identifying disease causing mutations and patient specific differences. Our de novo based approach of generating de novo sequencing tags allows us to further investigate clinical datasets by identifying variants. Integrated seamlessly with PEAKS online is the SPIDER algorithm. SPIDER can identify these variants by matching de novo sequencing tags to database proteins by making allowances for homology peptide mutations. The SPIDER algorithm has the ability to detect differences between the de novo sequenced proteins and the sequences provided in a database, offering the power of identifying patient variants when a patient-specific database is not available.

CONCLUSIONS: PEAKS online provides an efficient, time-effective solution to search large-scale systems biology level proteomic experiments with unparalleled accuracy and the ability to identify patient specific variants in protein sequences.


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Maternal Glutaric Aciduria Type 1 (GA 1) Detected Through Newborn Screening in Croatia

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Poster #18c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Glutaric aciduria type 1 (GA-1; OMIM#231670) is an autosomal recessive inborn error of metabolism caused by deficiency of glutaryl-CoA dehydrogenase (GCDH) located in the catabolic pathways of L-lysine, L-hydroxylysine, and L-tryptophan. The enzymatic defect gives rise to neurotoxic metabolite glutaric acid (GA) and 3- hydroxyglutaric acid
(3-OH-GA) in the urine, and to glutaryl carnitine (C5DC), the marker metabolite used for newborn screening (NBS) . As in most inborn errors of metabolism, the phenotypic spectrum of GA 1 is broad. Most untreated individuals with GA-1 experience acute encephalopathic crises during the first six years of life that are triggered by infectious diseases, febrile reaction to vaccinations, and surgery. However, a small group of untreated GA 1 patients remains asymptomatic, even in adult life. Treatment for GA-1 consists of a low lysine diet, carnitine, and high-energy intake during illness.
OBJECTIVES: We describe a woman with GA 1 in whom the diagnosis was unsuspected until a low free carnitine level was found in her twin infants during routine newborn screening.
METHODS: Samples for NBS were prepared using Recipe reagent kit ClinSpot ® Complete Kits, amino acids and acylcarnitines in dried blood spots (DBS) on a tandem mass spectrometer coupled with high performance liquid chromatography, LC-MS/MS (MS8050 coupled with UPLC Nexera, both Shimadzu). Samples were ionized using electrospray ionization (ESI) in positive ion mode. Concentrations of individual acylcarnitine and amino acid species were calculated using isotope-labelled internal standards of known concentration for each analyte.
Urine organic acids were analyzed on capillary gas chromatography coupled with mass spectrometry (GC-MS-QP2010Plus, Shimadzu).
RESULTS: Isolated carnitine deficiency was found in one of the twin infants. The free carnitine (C0) concentration at day 3 in the newborn screening was 6.2 µmol/L (cut-off >8.8). Confirmation tests included plasma and DBS acylcarnitine profile for infants and their mother. The maternal DBS acylcarnitine profile showed markedly elevated glutarylcarnitine (C5DC= 1.9 µmol/L, cut-off <0.35) and decreased C0 (C0=4.0, cut-off >10). All of the metabolic findings of the baby were normal except for very low free carnitine level. Additional metabolic testing for mother showed clear elevations of glutaric and 3-hydroxyglutaric acid in urine organic acid analysis. Neonatal parameters normalized during the following weeks and confirmatory work-up of the non-affected neonates is negative.
CONCLUSION: An asymptomatic woman with GA 1 was detected through her infant´s newborn screening. This case has confirmed that expanded NBS may, besides expected reduction in the number of deceased or affected children, also yield other useful results: It can detect certain diseases in a mother, some acquired diseases in newborns and diseases in siblings of ill children detected by screening.


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Affinity Capture of a (Glyco)protein: Getting Your Sample Ready for the Mass Spectrometer

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Poster #12a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction:

Extracting a pure sample of the target protein from a complex biological fluid is often crucial for reliable, repeatable and sensitive results in mass-spectrometry analysis. Special attention is to be paid to the targets with abundant PTMs, such as glycosylation. In this work we present a comparison of different affinity capturing techniques used to isolate a low-concentrated glycoprotein from biofluids, while minimizing protein background in the eluate. Alongside with that, we offer a roadmap for a capturing method development, with mapped pitfalls and points of attention.

Objectives:

Perform an evaluation study of low-concentrated protein enrichment strategies.

Methods:

This work explored the efficiency of affinity capturing methods exploiting various solid supports. Performances of sepharose-beads, amine-terminated and NHS-terminated magnetic beads, as well as monolith-immobilized gold nanoparticles were evaluated and compared in terms of capturing efficacy and background protein contamination. Key workflow steps, such as carrier vial choice, drying procedure and elution methods were determined and explored. The tests were conducted on a set of biological matrices, that differ in protein concentration and physical properties. Nanobodies (single-chain antibodies) were used in the majority of tests, showing potential as a low-cost and stable substitute of full-size monoclonal antibodies. As an extra development, we present aptamers-based approach: a promising affinity capturing ligand with unique properties and simplicity of production.

Results:

We state magnetic beads to be the preferred option for in-solution affinity capturing and highlight the value of monolithic column for background reduction in the eluate. The capturing efficacy with the method reaches 70% and the method is applicable for complex sample matrices. The resulting eluate yield is suitable for subsequent mass-spectrometry analysis.
We also present an established roadmap for affinity capturing method development.

Conclusion:

The methods we explored are valuable as a (glyco)protein enrichment step prior to mass spectrometry analysis and offer potential for exploring low-abundance protein targets in the protein-rich matrices.


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Metabolomic Barometer of Gestational and Postpartum Weight in Overweight Pregnant Women

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Poster #11b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Background: Obesity amongst women of reproductive age is increasingly common in developed nations and has been shown to adversely affect childhood cardio-metabolic, respiratory and cognitive-related health outcomes in offspring. Metabolomic signatures of obesity are readily captured in biofluids samples and could potentially provide a molecular barometer for monitoring excessive gestational weight gain (GWG) and postpartum weight loss (WL) in overweight/obese pregnant women.
Methods: Urine and blood plasma samples were collected from 114 overweight or obese ethnically diverse pregnant women from Chicago (USA), as part of a randomised diet and lifestyle intervention trial (Maternal Offspring Metabolics Family Intervention Trial; www.clinicaltrials.gov NCT01631747). Blood plasma lipids and urine samples at 15 weeks, 35 weeks of gestation, and at 1 year postpartum were respectively analysed by LC-MS and NMR.
Results: Urinary 4-deoxyerythronic acid was found positively correlated to body mass index (BMI) and a broad spectrum of alterations in levels of blood plasma phosphatidylcholines, lysophospholipids, and sphingomyelins were associated with BMI, GWG, and WL. Specifically, several plasmanyl-/plasmenyl-phospholipids were negatively associated with GWG, and lysophosphatidylcholines (including LPC 20:4) were positively associated with WL. Multiple lipids with apparent 18:2 fatty-acid chains were significantly associated with GWG/ WL, suggesting linoleic acid, an essential nutrient, may play an important role in prenatal and postpartum weight management.
Conclusions: Maternal obesity-related parameters are associated with urine and plasma metabolomic profiles, which could be further exploited to evaluate the beneficial effect of diet and lifestyle intervention in pregnancy.


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Multi-Platform Correlation of Exhaled Volatile Organic Compounds by GC-MS, PTR-MS and SIFT-MS

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Poster #13c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
Numerous studies have independently shown that the profile of volatile organic compounds (VOCs) within exhaled breath can predict presence of human disease, including cancer1. Significant variation in the way in which breath samples are collected and analysed has largely prevented validation of these findings. Under the correct circumstances different analytical approaches may be complementary in their ability to detect, identify and quantify biomarkers2. The purpose of this study was to perform multiplatform correlation of VOCs levels within standardised breath samples using the three principal analytical modalities within breath research.

Objectives
The primary objective of this study was to describe the correlation VOC levels detected within standardised breath sample analysed by Gas Chromatography-mass spectrometer (GC-MS), proton transfer reaction-Time on Flight-mass spectrometer (PTR-ToF-MS) and selected ion flow tube-mass spectrometer (SIFT-MS).

Methods
Twenty healthy subjects were required to provide a single six-litre breath sample by exhaling into a Nalophan bag of the same volume. Ten VOCs from six chemical classes were analysed by GC-MS, PTR-ToF-MS and SIFT-MS. Breath samples were first simultaneously analysed by direct injection (on-line) PTR-MS and SIFT-MS using the H3O+ precursor ion. Breath was subsequently transferred to thermal desorption (TD) tubes (500ml per tube). TD tubes would be analysed by PTR-MS (H3O+) and GC-MS. The results would be compared using Pearson’s correlation coefficient.
Results
Whilst measured concentrations were higher with the SIFT-MS compared to PTR-MS, a good correlation was maintained. Levels of acetone, isoprene, fatty acid (C2 to C6), alcohols, and phenol were strongly correlated (R2>0.8; P<0.001). Broadly equivalent results were achieved when breath was analysed by either direct injection- or TD- PTR-MS (R2>0.8; P<0.001). Comparison of TD-PTR-MS and TD-GC-MS determined acceptable correlation in the analysis of acetone (R2>0.8; P<0.001) and isoprene (R2>0.8; P<0.001).
Conclusion
Results are intended to provide better understanding of the variance seen in breath data in turn supporting recommendations for optimisation of future analytical strategies. Findings indicate good correlation of results for SIFT-MS and PTR-MS for direct and TD sampling. Further optimisation of GC-MS settings and column will be required for studies hoping to provide cross-platform validate the results of breath analysis.

Reference
1. Kumar, S., et al. (2015). "Mass Spectrometric Analysis of Exhaled Breath for the Identification of Volatile Organic Compound Biomarkers in Esophageal and Gastric Adenocarcinoma." Ann Surg 262(6): 981-990.
2. Tomasz Majchrzak, et al. (2018). “PTR-MS and GC-MS as complementary techniques for analysis of volatiles: A tutorial review.” Analytica Chimica Acta(1035): 1-13.


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A Multi-Assay for the Quantification of Seven Steroid Hormones and Precursors in Serum with LC-MS/MS

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Poster #21b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
The analysis of steroid hormones is an important part of the diagnostic workup of many conditions caused by disorders in the hypothalamic-pituitary-adrenal (HPA) axis and gonads. Examples include Cushing’s syndrome characterized by cortisol excess, and congenital adrenal hyperplasia resulting from enzyme deficiencies leading to altered production of glucocorticoids, mineralocorticoids and sex steroids, female hyperandrogenism and male hypogonadism.
Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a highly specific and sensitive methodology suited for rapid analysis of multiple analytes in a clinical laboratory. The simultaneous detection of multiple steroid hormones in one sample has the advantage of increased precision and cost-efficiency.

Objective
To develop an LC-MS/MS multi-assay for the quantification of seven endogenous steroid hormones and precursors in serum: 17α-hydroxyprogesterone, androstenedione, testosterone, dihydrotestosterone, cortisol, cortisone and 11-deoxycortisol, for use in our routine clinical laboratory.

Method
Automated sample preparation was performed using a robotic liquid-handling system (Hamilton). Starting with 200 µl of serum, samples were mixed with deuterated internal standards followed by hydrophilic-lipophilic solid phase extraction (Oasis HLB, Waters). The steroids in a 20 µl aliquot of eluate were then separated by reversed phase ultra-high performance LC (Acquity UPLC HSS T3 column, Waters) and detected by positive mode MS (TQS, Waters) with a total runtime of 20 min per sample.

Results
The limit of quantification was in the low nmol-range or below for all seven compounds, with acceptable linearity (R2 > 0.99) within their respective measuring range, which included each reference range. The total coefficient of variation of the assay was < 7%.

Conclusion
Our newly developed LC-MS/MS-based multi-assay of seven steroid hormones and precursors in serum will aid in the diagnostic process of disorders of the HPA axis and gonads. It also has the potential to be of use in patient follow-up care.


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Diagnosis of Carcinoid Tumors in the Small Intestine by LC-MS/MS Analysis of 5-Hydroxyindoleacetic Acid (5-HIAA) in Serum

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Poster #22e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction
Carcinoid tumors are neuroendocrine tumors (NET), mainly occurring in intestines. In most cases the neoplastic cells produce serotonin, which is metabolized to 5-hydroxy-indolacetic acid (5-HIAA). In Sweden 50-100 new cases are discovered annually. For diagnosis, determination of urinary output of 5-HIAA for 24 hours have been used.

Objective
To establish an automated method for quantitation of 5-HIAA in serum using LC-MS/MS.

Patient samples
Serum samples were collected from healthy student volunteers. Patient serum specimens were admitted for analysis to the Clinical Chemical Laboratory, mainly from the Department of Endocrine and Sarcoma Surgery, Karolinska University Hospital. The patients were fasting, and should not have consumed food rich in serotonin 24 hours before drawing the blood samples.

Methods
Sample preparation were carried out by a pipetting robot (Hamilton MicrolabSTARlet). Briefly, to the serum samples were added an internal standard of 3H-labelled 5-HIAA, and proteins were precipitated with acetonitrile. Phospholipids and precipitated proteins were then removed by a ‘phospholipid removal plate’ (Phenomenex), whereafter acetonitrile was evaporated and 0.2% formic acid was added. The amount of 5-HIAA was determined by reversed phase chromatography and tandem mass spectrometry (Waters, Acquity-Xevo TQ).

Results
Total CV of the method was 6.5% at 690 nmol/L and 7,4 at 146 nmol/L The limit of quantification was determined to 25 nmol/L (CV less than 20%). Linearity range from 25 – 3600 nmol/L. Standard addition experiments in serum showed accuracies between -4.8 to to 2.6% and comparison experiments with an external laboratory showed acceptable agreement. The highest values in patient samples were 9,000-10,000 nmol/L, and these patients all had NET tumors with metastatic spreading. Generally, most patients having pathologically elevated serum concentrations also showed increased excretion of urinary 5-HIAA during 24 hours. In cases with only slightly elevated serum levels of 5-HIAA (up to 200 nmol/L), urinary excretion of 5-HIAA usually was not elevated.

Conclusions: Quantitation of 5-HIAA in serum is a useful and reliable method for diagnosis of intestinal carcinoid tumors. The analysis is less laborious than determination of 5-HIAA in urine and more convenient for the patients.


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Comparison of Three Automated Data Processing and Reporting Approaches for Inborn Errors of Metabolism by LC-MS Flow Injection Analysis for Clinical Research

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Poster #26e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: With the advances of tandem mass spectrometry (MS), it is now easier to identify inborn errors of metabolism (IEM) for clinical research. However, there are some practical challenges in processing and interpreting MS data, for example, 1) an increasing number of targets for research, 2) the complexity, time, and effort of data interpretation, and 3) the lack of hands-on experience due to the occurrence of rare diseases. The success of an IEM workflow depends largely on how it processes, interprets, and integrates data and information from multiple sources. Automated reporting and interpretation tools are solutions which could streamline or expand the capability of data processing software for efficient data review, and rapid report delivery.

OBJECTIVES: This study was to evaluate and compare three automated data processing and reporting approaches, including evaluations of data acquisition, peak integration, concentration calculation, data reporting and interpretation, and ease of use.

METHODS: Dried blood spot samples were extracted and injected onto a Thermo Scientific TSQ Fortis MS by flow injection analysis (FIA) using a Vanquish Flex HPLC. The generated data files were processed using 3 different software packages: 1) Thermo Scientific™ TraceFinder™ software Version 4.1, 2) Thermo Scientific™ Chromeleon™ 7.2, and 3) iRC PRO software, (2Next srl and Fantoni, Prato, Italy). Custom report plug-in templates were created for TraceFinder(TF) and Chromeleon(CM) to perform data reporting and interpretation.

RESULTS: All three approaches could generate the desired results and perform user-defined meta calculations. From the view of the completeness of a start-to-finish strategy, both TF and CM could control instrument, acquire, process, and report data. While IRC PRO could only process and report data. For peak integration, all could do time-ranged integration, which is preferred by data from FIA analysis. However, IRC PRO does not allow user review of peak integration. TF and CM allow full user review of integrated peaks as well as adjusting compound specific integration parameters. IRC PRO and TF have built-in calibration mode for concentration calculation. CM needs to take advantage of a plug-in template to perform the calculation. IRC PRO has built-in data report and interpretation, while both TF and CM need a plug-in template to include those functions and bridge the gaps. However, the plug-in templates could expand the functions according to user needs and have more reporting flexibility. For easy of use, IRC PRO is very simple and straight-forward, but needs to import data from data acquisition software. TF and CM could integrate plug-in template into data acquisition step, with even less manual intervention.

CONCLUSION: All three approaches could significantly improve productivity, timeliness, quality management, and communication.


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Rapid Evaporative Ionisation Mass Spectrometry (REIMS): A Diagnostic Tool for Omental Metastases in Patients with Primary Ovarian Cancer

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Poster #7c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
In the new era of precision surgery, novel tools for real-time tissue diagnosis during surgical procedures are required that will enable surgeons to personalise intraoperative decisions improving patients’ outcomes. Currently, surgical strategy is based on pre-operative imaging and visual assessment of anatomy intra-operatively, with postoperative histology guiding the necessity for any future intervention.This approach is often subjective, time-consuming, and costly. In patients with advance ovarian cancer, the metastatic lesions found at staging laparoscopy undergo subjective visual assessment by the surgeon and does not yield to any biochemical information about the cancer.Rapid Evaporative Ionisation Mass Spectrometry(REIMS) performs real-time chemical analysis of biological tissues utilising electrosurgery-generated aerosols. Here, we integrated REIMS with the Harmonic scalpel, an advanced laparoscopic surgical instrument, assessing its efficacy in diagnosing omental metastasis.
Methods
Patients undergoing surgical resection for ovarian cancer with omental metastasis were recruited at Hammersmith Hospital, UK, as part of a prospective cohort study. Fresh frozen normal and tumour-infiltrated omentum samples were analysed ex-vivo using a Harmonic ACE® +7 fitted with a tapered-tip blade (Ethicon). Sampling was performed at 5W, with aerosols aspirated into a Xevo G2-XS QToF mass spectrometer (Waters). The relative abundance of cellular metabolites was subjected to multivariate statistical analyses including principle components analysis and orthogonal partial least squares discriminant analysis in SIMCA (Umetrics). The ability of REIMS to predict the presence of tumour infiltration was assessed using leave-one-spectrum-out cross-validation. Univariate statistical analysis was performed in R Studio.
Results
2 patients with ovarian primary cancer were included (median age 57). 22 normal and 23 tumour-infiltrated omentum samples were analysed resulting in 45 spectra. REIMS was able to accurately distinguish normal from tumour-infiltrated omentum tissue in the range of 100-1000Da, demonstrating an overall diagnostic accuracy of 100% (sensitivity 100%, specificity 100%). The relative abundance of metabolites in the mass-to-charge range of 100-550 and 600-1000 were responsible for differentiating the normal and tumour groups; corresponding to a variety of cellular lipid species. Significant characteristic species (p<0.05) associated with the separation were predominately Triglycerides, Phospholipids (600-1000Da) and Fatty Acids (100-550Da). Putative identification was done using Metlin and Lipid maps.
Conclusions
REIMS can be coupled to the Harmonic surgical device to accurately distinguish tumour-infiltrated and normal omentum in patients with ovarian cancer. This can provide the surgeon with real time tissue feedback of indeterminant lesions, allowing intra-operative decision making to improve clinical outcomes.


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Non-classic Congenital Adrenal Hyperplasia and Polycystic Ovary Syndrome Differentiation Using a Commercially Available LCMS/MS Steroid Profile Kit: A Case Report

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Poster #14g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Hyperandrogenism and oligomenorrhea are common traits of patients with polycistic ovary syndrome (POCS) and nonclassic congenital andrenal hyperplasia (NCAH). As these disorders have a similar presentation, their distinction using solely clinical symptoms is difficult. Of steroid hormones, 17-hydroxyprogesterone concentration is commonly used as discriminator between POCS and NCAH, although the universal cut off value is not yet established.
OBJECTIVES: To evaluate steroid hormone profile for differentiation of NCAH from PCOS in a patient.
METHODS: A 24 years old female patient visited endocrinologist because of acne, mild hirsutism and sporadically excessive sweating accompanied with hot flashes and tachycardia. Her menstrual cycles were regular, as it was ovary ultrasound. Patient also did an ergometry and heart ultrasound due to the sporadically high blood pressure and dyspnea, but these findings were not remarkable. As a part of laboratory work-up, steroid hormone profile which included cortisol, 11-deoxycortisol, 21-deoxycortisol, 11-deoxycorticosterone (11-DOC), dehydroepiandrosteronesulphate (DHEAS), androstendione, testosterone and 17-hydroxyprogesterone (17-OHP), was measured in morning serum obtained during early follicular phase using Recipe ClinMass Steroid in Serum/Plasma kit and Shimdzu Nexera X2 liquid chromatograph coupled with Shimadzu LCMS-8050 mass detector. FSH and LH were measured with chemiluminescent microparticle immunoassay on Abbott Alinity i analyser.
RESULTS: Concentrations of steroid hormones were: cortisol 377 nmol/L (R.I. = 127 – 568), 11-deoxycortisol 9.8 nmol/L (R.I. < 3.1), 11-DOC 1.4 nmol/L (R.I. < 0.3), DHEAS 0.64 µmol/L (R.I. = 1.2 – 8.7), androstendione 12.3 nmol/L (R.I. = 1.2 – 8.7), testosterone 2.52 nmol/L (R.I. = 0.07 – 1.56) and 17-OHP 8.1 nmol/L (R.I. < 5.6). Concentration of 21-deoxycortisol was bellow limit of detection. FSH and LH were within the reference value.
CONCLUSION: Although clinical symptoms were mild, steroid profile and gonadotropin hormone measurement pointed to the NCAH. 11-DOC has mineralocorticoid effect and its elevated concentration is responsible for the elevated blood pressure, while increased testosterone and androstendione contribute to the acne and hirsutism occurrence. Elevated 17-OHP, 11-deoxycortisol and 11-DOC, decreased DHEAS together with elevated concentrations of other hormones from the profile, suggests 11β-hydroxylase deficiency. Steroid profile measurement is useful in PCOS and NCAH differentiation, as well as in distinguishing subtypes of CAH.


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Towards a LC-MS/MS Method for the Quantification of Serum Symmetric Dimethylarginine and Asymmetric Dimethylarginine for Use in a Routine Clinical Laboratory

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Poster #8b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Background
Symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA) are metabolites of the amino acid L-arginine. Recently there has been increasing interest in the utility of SDMA and have shown potential as an alternative to estimated glomerular filtration rate (eGFR), however, the use of GC-MS or long analytical run times has hindered the availability of analysis in routine clinical laboratories. Here, we describe the development of a rapid and simple LC-MS/MS method to help better-understand the utility of SDMA and ADMA in a routine clinical biochemistry lab.

Objectives
To develop and validate an LC-MS/MS method for measurement of serum SDMA and ADMA. The method has then been applied to undertake an in-house comparison with a published HILIC method. The methods were used to look at the correlation between SMDA and ADMA in patients with normal (eGFR >90) and impaired (eGFR <90) renal function.

Methods
The protocol from the published HILIC method was adapted and performed on a Waters Xevo TQS mass spectrometer; samples were introduced and subjected to a protein crash and subsequent dilution with acetonitrile prior to introduction into the LC-MS/MS system. The new method utilised a cation exchange column (CEX) and was undertaken on a Waters Xevo TQS Micro mass spectrometer, the sample preparation was the same as above as it was fast and simple. Partial validation was carried out for both methods, sample comparisons were undertaken to both investigate the suitability of the CEX method and to see how well SDMA, ADMA and ratios of both compared with creatinine concentration which was measured using an automated platform.

Results
The method was validated against an industry standard with recovery, ion suppression and imprecision all within acceptable limits for both methods. However, sample comparisons showed there to be slight differences in the CEX method from the HILIC method even though the same calibrators and preparation procedure were used. SDMA concentrations showed good correlation with creatinine in normal patients.

Conclusion
Extraction and analysis of SDMA/ADMA is very pH sensitive, therefore we postulate that pH differences between the HILIC and CEX methods may account for the small positive bias. However, due to there being no reference materials available it is difficult to identify which assay is accurate.


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An LC-MS/MS Method for Simultaneous Measurement of Five Antimicrobial Drugs (Vancomycin, Gentamicin, Amikacin, Linezolid and Teicoplanin) for TDM

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Poster #20b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
Nowadays, some clinical outcomes of patients treated with antibiotic drugs strongly suggest their therapeutic drug monitoring (TDM) in order to assess efficacy, compliance and side-effects.Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) is now recognized as pivotal for measuring any xenobiotic molecule in biological fluid. However, besides the incontrovertible advantages of accuracy, precision and cost-effectiveness of LC-MS/MS, there is usually the need to rely on an isotopically-labeled internal standard for mitigating any matrix and/or recovery issues. Nonetheless these labeled compounds can pose availability and cost constraints when related to newly-introduced pharmaceutical drugs.

Objectives
The hereby-presented protocol is centered on a new application kit and relies on a special plumbing which implements a fast on-line sample cleaning.

Method
The LC-MS/MS approach, characterized by a fair chromatographic capacity factor value (K), enables the simultaneous measurement of Vancomycin, Gentamicin, Amikacin, Linezolid and Teicoplanin, on protein-precipitated plasma and with a non isotopically-labelled compound proposed as for internal standard.

Results
Ion-suppression effect has been assessed meanwhile overall matrix effect has been less than 6.5%. With a linearity tested in the respective ranges for the five drugs (R² = 0.999 for Gentamicin C1 between 0.045-2.25 ug/mL, the lowest range), method comparison with immunometric measurements on 30 patient samples has given an equation: y = 0,8837x + 1,5154 (R² = 0,9956) for Amikacin on plasma samples spanning between 1.0 and 100 ug/mL; and an equation: y = 0,8861x + 3,2712 (R² = 0,9544) for Vancomycin on samples spanning between 20 and 40 ug/mL.

Conclusion
The LC-MS/MS setting has allowed to split and measure the main components of Gentamicin, an aminoglycoside, and of Teicoplanin, a glycopeptide, for supporting any study related to alleged different antimicrobial potency of single components.


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Developing an LC-MS/MS Method for 29 Antihypertensive Drugs in Urine

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Poster #22f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Hypertension is a major preventable cause of morbidity and mortality which affects one in four adults. Despite this, high rates of non-adherence to antihypertensive medications have been reported both in the U.K. and worldwide. Poor adherence to medications results in wasted resources, sub optimal treatment and worse health outcomes for patients. Objective measurements of adherence to treatment for hypertension such as LC-MS/MS measurement of drugs in urine have been proven to help identify these patients and allow therapy to be adapted. This has in turn improved patient outcomes. In NHS Lothian in Edinburgh, an initial pilot audit revealed that only 64% of patients with resistant hypertension adhered to their treatment regimen. This prompted the development of a local LC-MS/MS method to measure antihypertensive drugs in urine.
Aims:
1. To develop a qualitative LC-MS/MS method in NHS Lothian to test patient urine for 29 currently prescribed antihypertensive medications.
2. To validate the method for clinical application.
3. To use the method to estimate rates of non-adherence to antihypertensive therapy in NHS Lothian patients.
Results:
1. 22 of 29 antihypertensive medications chosen were able to be measured in patient urine.
2. 94% of patients with hypertension in NHS Lothian were fully adherent to medication (n=89 patient urines).
3. Of the patients with resistant hypertension (non-responders to treatment), 69% were adherent to medication. Three of these patients were partially adherent and one was completely non-adherent to therapy (total n=13).
Conclusions: An LC-MS/MS method has been developed which allows the identification of 22 of 29 antihypertensive drugs in patient urine. Validation work to include the remaining drugs and develop a routine service is ongoing.


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Development and Evaluation of a LC-MS/MS Method for the Quantitation of Isavuconazole in Human Serum Samples

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Poster #12c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Background: Therapeutic drug monitoring of isavuconazole, which is a novel broad spectrum antimycoticum against invasive fungal infections, ensures an effective exposure of the drug and minimizes the risk of toxicity (1). The aim of the present study was to evaluate a widely applicable LCMS method eligible for the clinical routine use for the quantification of isavuconaole.
Methods: The method was performed on a Voyager TSQ Quantum triple quadrupole instrument equipped with an Ultimate 3000 chromatography system (Thermo Instruments, San Jose, California, USA). Isavuconazole and the deuterated internal standard d4-isavuconazole were kindly provided by Basilea (Basel, Switzerland). A calibration curve was prepared using plasma samples spiked with six different isavuconazole concentrations ranging from 0.2–12.8 mg/L. The intra-day and the inter-day precision were assessed by replicate analysis (n=5) of three isavuconazol concentrations on the same day and on five consecutive days. Additionally, we investigated lower limit of detection (LOD), the lower limit of quantification (LLOQ), the recovery and preanalytical requirements.
Results: Calibration curves were linear throughout the selected ranges. The correlation coefficient (r²) always exceeded 0.99. The lower limit of quantification (LLOQ) was 0.05 mg/L. Within- and between assay CVs were between 1.4 – 2.9% and 1.5 -3.0%, respectively. The recovery ranged between 94 to 103 %. At room temperature serum samples were stable for five days.
Conclusion: The evaluated method is a precise and well suited diagnostic tool for the therapeutic drug monitoring of isavuconazole in clinical routine.

(1) Jenks JD, Mehta SR, Hoenigl M. Broad spectrum triazoles for invasive mould infections in adults: Which drug and when?. Med Mycol. 2019: 57; S168-S178.


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Exploring Optimal Protein Identification and Repeatability via Sequences of Fine-Tuned LC-MS/MS Runs

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Poster #20e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Shotgun proteomics is a high throughput method to identify peptides and proteins from complex biological samples. However, it is not an unequivocal procedure, due to the variability of LC-MS/MS experimental conditions and the search engine parameters used in data analysis. Further, in case of data-dependent approach, there may be significant run-to-run variability in the peaks selected for MS/MS analysis resulting in different set of identified peptides even from identical LC-MS/MS runs.

OBJECTIVES: This study aims to explore the combination of experimental settings leading to the largest number of identified peptides/proteins using a given measurement time frame. In the first stage, we focus on the effect of repeated identical measurements, while in the second stage investigation and optimization of chromatographic and Q-TOF instrumental settings are done to assess their influence on proteome coverage of HeLa standard sample. The performance of two commonly used sequence database search software packages, Byonic and Mascot is also investigated.

METHODS: We carry out various repeated nano-LC-MS/MS runs on HeLa tryptic digest on a Bruker Maxis II Q-TOF instrument. The data are searched against the SwissProt Human database. Further analysis and comparison of the output of the search engines files are done using the Scaffold 4 program. For optimization, according to recent literature, we test the following parameters: dynamic exclusion duration, mass-range, time of gradient. Design of experiments is used to evaluate significant factors and instrument performance is characterized with protein groups, unique peptides and spectral counts.

RESULTS: From a combined analysis of repeated LC-MS/MS runs, we found that 3 to 4 repeats are adequate to find about 90% of proteins and peptides in a sample with this complexity. A direct comparison of search engines using the LFDR-based (re)scoring system in Scaffold revealed that Byonic identifies a comparable number of proteins, but significantly more peptides. Further tests on different database sizes and mass spectrometric parameters allowed us to suggest a protocol with an optimal number of peptides or proteins for a given number of repeated measurements.

CONCLUSION: Our results demonstrate that proteomic measurements based on standard protocols can significantly benefit from targeted optimization and from using a small set of replicates to achieve appropriate coverage. Such optimization can thus lead to more efficient utilization of measurement time and enhanced repeatability, addressing a main concern in proteomics experiments.


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Targeted MMulti-OMICS: Rapid Plasma Profiling of a Bladder and Lung Cancer Human Cohort

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Poster #19f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
Cancer is a complex and life threatening diseases, existing in many forms which have unknown pathogenesis. A combination of factors are known to contribute to increasing the probability of encountering cancer. Lifestyle factors such as smoking are known to contribute towards both lung and bladder cancer, with lung cancer providing over 230,000 diagnosed cases in the United States annually. Here, we present a study comparing plasma samples from a cohort of bladder and lung cancer patients, with those of healthy controls using a high-throughput OMICS workflow. This LC-MS workflow allows for the rapid screening and semi-quantification of various compound classes and peptides using a single LC-MS platform.

Methods
A targeted OMICS solution was used for the rapid screening and semi-quantification of multiple compound classes using a single LC-MS and informatics platform. Plasma samples from a cohort consisting of bladder and lung cancer patients as well as those of healthy controls were analysed. All LC and MS methods were generated using the Waters Targeted OMICS method library, and did not require any optimization.
A known level of labeled analogues from each compound class was added to each sample. The level of each analyte was estimated from its ratio to the appropriate analogue.
LC-MS data were processed using Skyline. Additional visualization and analyses were performed using Metaboanalyst.

Preliminary results
Data was collected for 18 plasma samples (6 controls, 6 bladder cancer and 6 lung cancers), each sample was run in duplicate (proteins) or triplicate (acylcarnitines and amino acids). Pooled QC's were acquired every 9th inj.
128 compounds were detected and quantified using Skyline, generating a %CV less than 20% for the QC samples: 80 proteins, 20 acylcarnitines and 28 amino acids. High precision was demonstrated for the the quality control samples. Valine-d8 (spiked in all samples for the amino acid screening) is used as an example to illustrate the consistency of peak area across the whole study (<5% CV).
Pair-wise comparisons using a t-test were performed on each compound class. 12 compounds were highlighted as differentially expressed between bladder / control and 11 between lung / control. For example, the amino acid sarcosine was demonstrated to be up-regulated in both lung and bladder cancer samples; the acyl carnitine analysis highlighted Octenoyl carnitine (C8:1) as being down-regulated in the bladder cancer cohort; and the protein analysis found that various analytes were differentiating, including Apolipoprotein C-III and H

Overall the data demonstrated the ability of this targeted OMICS approach to highlight potential and relevant markers of interest in a simple and rapid manner. There was no need for method development and results were obtained in less than 24 hours. The next step in the study would be to concentrate on the highlighted markers and validate them by performing a more statistically rigorous study.


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Enterobacter: When MALDI-TOF (VITEK® MS) and New Taxonomy Speak as One Voice

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Poster #7b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: The species belonging to the Enterobacter genus are responsible for 5 to 10% of infections among patients hospitalized in intensive care units and are primarily due to the members of the Enterobacter cloacae complex (ECC). This complex is divided into 13 clusters with 6 defined species E. asburiae, E. cloacae, E. hormaechei, E. kobei, E. ludwigii and E. nimipressuralis.
New Enterobacter species and sub-species have also recently been described such as
E. bugandensis associated with neonatal sepsis.

Objectives: In this study, we demonstrate that the use of MALDI-TOF technology coupled with well characterized strains improves Enterobacter genus identification and is in accordance with the new genus taxonomy.
Methods: 76 Enterobacter strains were characterized by sequencing of the gyrB gene. MALDI-TOF acquisitions were performed by direct deposit after addition of 1µL of CHCA, bioMérieux, and within the mass range of 3.000-17.000 Da.
Data were analyzed using dendrograms and performances were evaluated using a cross-validation approach.
Results: The dendrogram showed that a clear differentiation is possible between the different Enterobacter species or even sub-species. The clustering obtained using MALDI-TOF corresponds to the newly described taxonomy of this genus (Int J Syst Evol Microbiol 2018;68:3379–3393 DOI 10.1099/ijsem.0.003071).
Cross validation study was performed to evaluate the performance of the updated database, containing 40.458 spectra covering 1199 bacterial species.
Species within the ECC could be separated using MALDI-TOF. They could even be identified at sub species level for E. cloacae and E. hormaechei. The preliminary performances showed 83.8 to 100% of correct identification for all Enterobacter species including new species except E. kobei for which a high rate of NoID results (29.8%) was observed, probably due to heterogeneity of the species as demonstrated by the existence of two different type strains.

Conclusions: This study demonstrates that MALDI TOF is a reliable tool to differentiate close species of Enterobacter like species within the ECC and also to identify new highly pathogenic species like E. bugandensis such helping patient care and reducing time to appropriate antibiotic therapy.


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Validated High-Sensitive Steroid Profiling in Human Serum Using LC-MS/MS

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Poster #6d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Steroid profiling is of clinical significance for the diagnosis of a wide variety of diseases as steroids play a major role in the regulation of several physiological functions. Historically, these analytes have been measured using immunoassays. However, it is now established that these methods suffer from lack of specificity, due to cross-reactivity. Mass spectrometry has become a standard for accurate steroid profiling, taking advantage of its specificity, high sensitivity and the ease of sample preparation. Nevertheless, due to their small size and their large range of polarity, the analysis by LC-MS/MS is still a challenge.

METHOD: Here we present a method for high-sensitive steroid profiling in human serum using LC-MS/MS. This method was validated and is now used in routine in a French hospital. The analysis was performed using Nexera X2 high performance liquid chromatography (Shimadzu Corporation, Kyoto) and LCMS-8060 triple quadrupole mass spectrometer (Shimadzu Corporation, Kyoto). MRM parameters were optimized using LabSolutions software (Shimadzu Corporation, Kyoto). Sample preparation consists of a supported liquid extraction (SLE), followed by evaporation. The analytical separation was performed on a Raptor Biphenyl 2.7μm 50x3mm (Restek Corporation, State College, PA), using water and methanol as mobile phases, and ammonium fluoride as additive.

RESULTS: The method was validated for the analysis of 10 steroids in serum: aldosterone, 11 deoxycortisol, corticosterone, 17OHP, testosterone, androstenedione, progesterone, DHEA, DHEA sulfate, estradiol. Validated low limits of quantification (LLOQ) confirmed the high sensitivity of the method: 0.025 ng/mL for aldosterone, 0.09 ng/mL for 11-deoxycortisol, 0.5 ng/mL for corticosterone, 0.1 ng/mL for 17OHP, 0.06 ng/mL for testosterone, 0.2 ng/mL for androstenedione, 0.1 ng/mL for progesterone, 1 ng/mL for DHEA, 100 ng/mL for DHEA sulfate, 0.04 ng/mL for estradiol. For all analytes, r² of linearity models were above 0.99, with S/N > 10 for LLOQ levels. Accuracies of calibration and QC samples were comprised in between 85 and 115% for all analytes. Additionality results were correlated with external validated reference methods, presenting a good correlation.

CONCLUSION: The method proved it fits for purpose and is now used for routine analysis in this hospital.


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Collision-energy breakdown curves – an additional tool to characterize MS/MS methods

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Poster #21e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: A fundamental assumption in quantitative mass spectrometry is that the internal standard compound behaves identical on all stages of the analytic process chain (ionization-fragmentation-detection) in relation to the target compound and is so used to compensate any inconsistency during sample preparation and analysis. Differential impact of matrix effects on these processes can potentially affect accuracy and sensitivity. Consequently, it can be of significance to investigate the fragmentation characteristics of compounds comparatively (analyte vs. internal standard compound) and under various matrix conditions (reflecting different approaches to sample preparation) in addition to the usual investigated ion source phenomena. The evaluation of such experiments can be performed by breakdown curves, which can be described as a function of the collision energy.

OBJECTIVES: The objective of this approach was to study the ionization yield for various collision energy settings using two immunosuppressant compounds and visualizing the results as breakdown curves in plots.

METHODS: To study this approach, we investigated the immunosuppresants cyclosporine A and tacrolimus and the corresponding internal standards, 4-fold deuterated cyclosporine A and ascomycin as exemplary analytes, both on the background of biological sample matrix and in matrix free solutions for comparison. For this aim, a routine quantitative method used in the therapeutic drug monitoring, including protein precipitation followed by online solid phase extraction for these two immunosuppressants, was modified. Analyses were performed for two different concentrations and in duplicate and a mean of responses was calculated to generate the breakdown curve plots.

RESULTS: We found consistent breakdown curves for all four compounds studied, whereby the curves showed different patterns that were independent from the concentration. Slight differences were observed for the compounds in biological matrix-based samples compared to matrix free solutions, indicating potential matrix effects on fragmentation. Additionally, stable isotope-labelled 4-fold deuterated cyclosporine A showed an identical breakdown curve to native cyclosporine A, while ascomycin, used as an analogous molecule for internal standardization, showed a shifted breakdown curve of 5eV compared to tacrolimus.

CONCLUSION: We conclude that collision-energy breakdown curves may be an interesting additional tool to characterize MS/MS methods with respect to matrix effects and similarity of target analyte and corresponding internal standard compound.


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Expression of Cellular and Neurodevelopmental Markers in Cerebral Organoids

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Poster #16c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION:
The dementia epidemic affects 47 million people globally, with increasing incidence [1]. Cerebral organoids, derived from induced pluripotent stem cells, represents an emerging model system to study biological processes leading to the neurological diseases and to an exploration of novel hypotheses [2]. Prior to that, suitable tools are required to properly characterize cerebral organoids in terms of cellular composition and neuronal maturation [3,4].

OBJECTIVES:
Our aim in this study was to develop an assay based on selected reaction monitoring tandem mass spectrometry (SRM-MS/MS) to identify cellular and neurodevelopmental markers and applied the assay to cerebral organoids of various age. The multiplex assay determines expression levels of cellular markers attributable to a specific cell type, e.g. neuroepithelial cells (SOX2), radial glia (BLBP), immature neurons (DCX, TUJ), mature neurons (MAP2), serotoninergic neurons (SERT), postsynaptic proteins (GRIN1) and oligodendrocytes (OLIG2).

METHODS:
Cerebral organoids cultivated at Dept. of Histology and Embryology following the protocol published by Lancaster et al. [5] were collected on the day 47, 97, 120 and 145. Each organoid was individually lyophilized. Dried pellets were extracted into 50mM ammonium bicarbonate buffer. Protein mixtures were reduced, alkylated and spiked with isotopically labeled peptides used as retention indices for a prediction model. Samples were enzymatically digested by trypsin, purified by solid phase extraction, dried down and injected on C18 Peptide CSH column. Ultra-high performance liquid chromatography mass spectrometry with triple quadrupole mass analyzer (6495B series, Agilent technologies, CA, USA) was used to investigate cellular markers in positive ion mode. Measured data were normalized to a response of housekeeping protein Glyceraldehyde 3 phosphate dehydrogenase (GAPDH).

RESULTS:
We have identified cell markers represented by 2-4 proteotypic peptides with 3 5 transitions. We used Skyline software for peptide identification based on predicted retention time and product ions. The iRT Calculator was recalibrated using retention indices covering the chromatography gradient. We normalized the response of specific cellular markers to the response of the GAPDH. This workflow was used for identification and relative quantification of eight cellular markers characterizing various developmental stages in the organoids and for grouped comparative analysis in organoids of different age.

CONLCUSION:
In this study, we present multiplex SRM assay for identification of cellular markers, associated with specific cell type composition and dependent on the maturity of organoids. We discovered age-dependent variable levels of certain cell markers in organoids of different age.



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Evaluation of the Updated 25-Hydroxy Vitamin D Assay on the Cascadion SM Clinical Analyzer

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Poster #26g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
Evidence of the skeletal and nonskeletal effects of vitamin D, coupled with recognition that vitamin D deficiency is common, has raised interest in what is called a vitamin but is in fact a hormone. Vitamin D is produced by the action of ultraviolet B radiation on skin or obtained from dietary sources, including supplements. Persons commonly at risk for vitamin D deficiency include those with inadequate sun exposure, limited oral intake, or impaired intestinal absorption. Vitamin D sufficiency is best determined by measurement of 25-Hydroxy Vitamin D in serum, which allows precise evaluation of Vitamin D sufficiency as well as monitoring of vitamin D supplementation. In measuring 25-Hydroxy Vitamin D it is desirable that the C3 epimers should be separated, as significant epimer concentrations have been observed not only in newborns but also in adults and have a biological activity apparently different from vitamin D itself.

Material and Methods
This presentation details analytical data of the updated Vitamin D assay designed for the fully automated Thermo Scientific™ Cascadion™ SM Clinical Analyzer*. This includes the lower limit of quantitation (LLoQ), the Analytical Measurement Range (AMR), calibration, response linearity and stability, accuracy, precision, and specificity including epimer separation. Data from studies performed at Viollier AG comparing immunoassay-based vitamin D assay with the Cascadion SM LC-MS/MS technology evaluated of the relative performance of this integrated LC-MS/MS analyzer.

Results
Vitamin D2; Vitamin D3; Total Vitamin D
LLoQ 3.4 ng/ml; 3.4 ng/ml; 3.4 ng/ml
AMR 3.4 – 132 ng/ml; 3.4 – 132 ng/ml; 3.4 – 264 ng/ml
Stability of calibration
30 days; 30 days; 30 days
Precision 3.2 – 6.1 %CV; 2.9 – 7.6 %CV; 2.3 – 7.6 %CV
Accuracy of CDC samples for Total Vitamin D
Cascadion = 1.04 x CDC – 1.582ng/ml; R=0.9966

Conclusion
The 25-Hydroxy Vitamin D assay for Cascadion SM Clinical Analyzer delivers an analytical performance that makes it a convenient, reliable, and accurate method for assessing Vitamin D levels as well as monitoring of supplementation therapy. Stable calibration, reliable separation of epimers, and low interference from supplements such as biotin encourage the expectation that this assay on the Cascadion SM Clinical Analyzer will enable the use of LC-MS/MS in Vitamin D analysis within the routine clinical laboratory.

* Product is IVD/CE marked but not 510(k)-cleared and not yet available for sale in the U.S. Availability of product in each country depends on local regulatory marketing authorization status.


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Simultaneous Quantitation of Diabetes Markers and Comprehensive Metabolome Annotation Achieved via Semi-targeted Analysis of Serum Samples

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Poster #28f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Type 2 Diabetes (T2D), the most prevalent form of diabetes, is a metabolic disorder characterized by decreased insulin sensitivity and abnormal hepatic glucose production. Monitoring metabolic alterations during T2D progression may provide better understanding of its pathogenesis and identify potential biomarkers for early diagnosis. Several metabolomics approaches have been applied in diabetic research for identification of metabolites associated with the risk of T2D and related pathways. Here, a semi-targeted workflow was designed to confidently measure known metabolic differentiators, such as branched-chain amino acids, while allowing for the discovery of previously unidentified metabolites that are altered during T2D progression. This approach combines high resolution accurate mass Orbitrap™ technology for maximum detection of known and unknown metabolites in serum samples, with intelligence-driven fragmentation for the identification of knowns and structural elucidation of unknown biomarkers.

Methods: Serum samples were obtained from 3 healthy donors and 3 T2D donors. A pooled sample was created from all samples and was used for quality control and identification of unknowns. Metabolites were extracted with an excess of cold methanol (3x) containing internal standards. Samples were analyzed with a Thermo Scientific™ Vanquish™ UHPLC system and a Thermo Scientific™ Orbitrap ID-X™ Tribrid™ mass spectrometer. A custom library containing fragmentation spectra and retention times for 300 authentic standards was created in-house. Data were processed using Thermo Scientific™ Compound Discoverer™ software for unknown identification, differential analysis and pathway mapping.

Results: A semi-targeted workflow was developed for the robust quantitation of known markers, such as branched chain amino acids, while at the same time, enabling comprehensive metabolic phenotyping of serum samples. Over 3,000 metabolites were detected, 200 of which could be confidently identified (MSI Level 1) against an in-house spectral library. The Orbitrap ID-X Tribrid MS with AcquireX intelligent acquisition software maximized the number of metabolites interrogated by MS/MS, by annotating non-biological and redundant features on-the-fly, resulting in confident metabolite annotations. Putative annotations (MSI Level 2 and 3) were obtained for more than 90% of the metabolites detected through searches against the mzCloud™ library and ChemSpider database. Differential analysis detected metabolite perturbations in amino acids and carnitines in serum from T2D donors, in agreement with previous studies.

Conclusion: The semi-targeted strategy described here presents a promising and facile workflow for the monitoring of known biomarkers, while enabling the discovery of novel disease biomarkers that could lead to further biochemical insights in disease progression and treatment outcome.
For Research Use Only. Not for use in diagnostic procedures.


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Separation of Intact Parathyroid Hormone and Variants Using a Highly Sensitive Sheathless CE-ESI-MS/MS Method

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Poster #12d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION Parathyroid hormone (PTH) is a common clinical marker whose quantification relies on immunoassays, giving variable results as batch, brand, or target epitope changes. Moreover, immunoassays may cross-react with PTH variants such as C-terminal fragments stemming from PTH catabolism. These issues make it difficult to compare results obtained in different laboratories. A reference quantification method is necessary to harmonize PTH assays, both sensitive and selective enough to detect PTH at low concentrations among a variety of closely related compounds.
OBJECTIVES In this study, our main goal was to reach a very high sensitivity (pg/mL range) for the analysis of PTH and its variants. Two variants were selected, namely 7-84 PTH as C-terminal fragment and 1-34 PTH as related peptide, but also as potential internal standard for future works.
METHODS To achieve our goal, we developed a sheathless CE-ESI-MS method for the separation of 1-34 PTH, 7-84 PTH, and 1-84 PTH. Fused silica and neutral-coated capillaries were investigated, as well as preconcentration methods such as transient isotachophoresis (t-ITP), field-amplified sample injection (FASI) and electrokinetic supercharging (EKS).
RESULTS The method for the separation of PTH and its variants was first developed using fused-silica capillary with UV detection. 1-84 PTH (full length), 7-84 PTH and 1-34 PTH were separated using an acidic background electrolyte containing acetonitrile to reduce peptide adsorption onto the capillary wall. Ammonium acetate was used as sample medium to improve sensitivity through t-ITP. The method was then transferred to a sheathless CE-ESI-MS instrument. CE-MS on fused silica capillary was limited to µg/mL levels. Indeed, despite the MS detection, only samples containing at least 10 µg/mL of 1-84 PTH, 7-84 PTH, and 1-34 PTH could be analyzed. The use of a neutral coating combined with FASI or EKS allowed a significant increase in sensitivity. Under these conditions, 1-84 PTH, 7-84 PTH and 1-34 PTH were detected at 100 ng/mL using FASI while 1-84 PTH and 1-34 PTH were detected at 100 pg/mL using EKS. The estimated LODs (S/N = 3) for the EKS method were 25 pg/mL for 1-84 PTH and 10 pg/mL for 1-34 PTH, while there was no signal anymore for 7-84 PTH at these levels.
CONCLUSION The developed sheathless CE-ESI-MS method has the potential to reach the low pg/mL range in biological samples after the optimization of the sample preparation method.


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High-throughput Quantification of Immunosuppressant Drugs in Human Blood by LC-MSMS for Clinical Research

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Poster #6c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
The analytical validation of a clinical research method for the quantification of four immunosuppressant drugs (Cyclosporin A (CyA), Tacrolimus (TAC), Sirolimus (SIR) and Everolimus (EVE)) in whole blood is reported. The present method allows low level quantitation (CyA 10 ng/mL, TAC, SIR, EVE at 0.5 ng/mL) which makes it especially suitable for clinical research studies. At the same time the method was adapted for high throughput analysis using multi-channeling, delivering results in less than one minute per injection. Method performance was evaluated in terms of linearity of response within the calibration ranges, selectivity, accuracy, and intra- and inter-assay precision and carry-over for each analyte.

Methods
Whole blood was extracted by offline protein precipitation and internal standard addition into a 96 well plate by an automated procedure using a Hamilton™ robotic liquid handler. The plates were centrifuged and the supernatant injected onto a Thermo Scientific™ Transcend II™ system connected to a Thermo Scientific™ TSQ Quantis™ triple quadrupole mass spectrometer. Detection was performed by selected reaction monitoring (SRM) using four isotopically labeled internal standards. The LC column used was a Thermo Scientific™ Accucore RPMS 2.1x30 mm. The system was used in multi-channel mode and the cycle time was less than 2 min/channel providing results from one injection in less than one minute. Data was acquired and processed using Thermo Scientific™ TraceFinder™ 4.1 software. The method was evaluated using the MassTox® calibrators and Quality Control Samples from Chromsystems Instruments & Chemicals GmbH (Munich, Germany). An additional level for both calibrator and Quality Control sample at LLOQ was obtained by dilution of a low level Qiuality Control sample with blank whole blood, providing calibration samples at 7 levels and Quality Control samples at 5 levels. The calibrated range was 9.5 -1950 ng/mL (CyA), 0.5-42 ng/mL (EVE, TAC) and 0.5 – 47 ng/mL (SIR). Five batches of data was collected on two indentical LC-MS/MS systems.

Results
The method proved to be linear in the ranges covered by the calibrators. The data from both systems demonstrated acceptable accuracy and precision with a bias between nominal and average calculated concentration for the control samples within ±20% at LLOQ and ±10% at higher levels. The %CV for inter- and intra-assay precision was <20% at LLOQ and <10% at higher levels for all the analytes.

Conclusions
A liquid chromatography-tandem mass spectrometry method for clinical research for the quantification of four different immunosuppressant drugs in whole blood was implemented. The method offers high throughput and accurate results to a level suitable for clinical research studies. The described method meets research laboratory requirements in terms of sensitivity, linearity of response, accuracy and precision and throughput.


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Plasma Lysosphingolipid Analysis by LC-Differential Mobility Spectrometry-MS/MS (LC-DMS-MS/MS): Rapid Sample Preparation and Resolution of Stereoisomers

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Poster #23b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
Research into plasma sphingolipids and determining the concentrations of such is of growing importance in the clinical research laboratory, particularly within groups researching Lysosomal Storage Metabolism. It is thought that plasma lysosphingolipids (LysoSLs) are potentially important biomarkers implicated in a range of sphingolipidoses Current methods of analysis primarily involve either enzyme activity procedures or derivatization of compounds prior to analysis. Direct analysis of these groups can be complex due to extensive structural homogeneity between individual compounds.

Sample Preparation:
Extraction was achieved by protein precipitation/direct injection approach utilizing 20μL of plasma

HPLC Conditions:
Short chromatography was provided by a C8 column and a gradient of acidified acetonitrile/water

MS/MS Conditions:
Sciex Triple Quad 6500+ fitted with SelexION DMS Technology, operating in Positive Low Mass MRM

Results
Ion Mobility can separate the stereoisomers Glu-and Gal-SPH in extracts without the need for chromatographic separation
Ion Mobility has been shown to remove interferences that can cause to misinterpretation of the results
Results and statistics in plasma show good Accuracy (88 – 105%) Precision (1.5 – 19%) and Linearity (>0.997) with sensitivity of all compounds in plasma significantly below 0.1ng/ml.
Results generated using this methodology in research samples show good correlation with current methodologies.

Conclusions
We have presented here a method for the direct analysis of a series of sphingolipids in plasma using a simple protein precipitation, standard chromatography and Differential Ion Mobility Spectrometry. This improved methodology for plasma LysoSL analysis using LC-DMS-MS/MS has a simplified sample preparation stage compared to previous methods and can differentiate between stereoisomers without the need for chromatographic separation. Biomarker analysis could be automated and is particularly useful where sample volume is limited (and insufficient for enzyme analysis) or where more invasive and time-consuming methods are currently employed, e.g. skin biopsy.


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Bioassay Classification Study via LC-MS and Machine Learning in Conjunction with Dimensionality Reduction

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Poster #19a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Metabolomics data often contain thousands of features, but only some of them keep useful information about clinical status and other types of system biology source of data. The one of the first step to the realization of global concepts (such as personalized medicine and system biology) is design a list of the most stable and robust approaches to the extraction of informative metabolites.
OBJECTIVES: The primarily aim of our research is attempt to employ machine learning principle for selection important features from metabolomics data without powerful and not stable preprocessing stages (such as QC-based correction, scaling, transformation, decompositions, etc.). We applied only creatinine normalization and half-minimum missing value imputation to raw data.
METHODS: LC-MS analysis of 40 urine samples was performed by C18 column (Waters) coupled with IT-TOF (Shimadzu) instrument. The metabolites data table after integration and alignment was obtained from iMet-Q software. All calculations for model training, resampling, tuning hyperparameters, variables importance sorting, feature frequency computing between different stage of resampling and recursive feature elimination were done by R environment (caret package in generally). Other computations were also produced throughout R software. The obtained pipeline of data engineering process was tested on one open repository metabolomics data.
RESULTS: In all datasets (experimental and from open repository) clinical groups were clearly and properly separated by hierarchical cluster analysis and principal component analysis. Correct pattern recognition was achieved for reduced datasets after feature selection based on combination of machine learning training and results of univariate analysis.
CONCLUSION: This report slightly demonstrate potential opportunities to creation and validation of some useful approaches for marker research in high dimensional data. Combination the efforts of many researchers can led to the adoption of more rational and robust techniques then the classical methods (ANOVA, FCA, PCA, VIP score from s,o – PLS-DA), especially for non-linear and complex issues.

This work was funded by the Russian Foundation for Basic Research (RFBR), according to the research project No. 19-33-90071.


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Analysis of Human Monocyte Volatiles by Solid-Phase Microextraction Combined with Two-Dimensional Gas Chromatography-Mass Spectrometry for Biomarker Discovery

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Poster #18d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction: Sepsis remains the leading cause of mortality in the intensive care units. Peripheral blood monocytes have central role in sepsis and are source of numerous effector molecules as well as diagnostic or prognostic markers. Volatile substances (VOCs) from serum samples might be used as reliable markers for detection of important metabolism changes related to innate cells exuberant activation. Therefore development of analytical methods for monocyte VOCs detection and identification is crucial for further characterization of monocyte metabolism alterations.
Objectives: The primary objective of this study was to develop and optimize fast and reliable analytical method for monocyte volatiles detection and quantification.

Methods: Monocytes were obtained from healthy individuals blood samples. Subsequently monocytes were treated by LPS or by ZYM in order to simulate bacterial or yeast infection, respectively. Cells were separated form their medium and bought fractions were analyzed by SPME-GC×GC-TOF MS method for the identification and quantification of monocyte VOCs profiles. For the SPME technique optimization, different fiber coatings, incubation conditions and adsorption times were tested. Brombutane was used for internal quantification, while 2-ethyl hexane-1-ol, nonanal and octanal were used as standards for external quantification. The GC×GC-TOF MS method has been developed and optimized for the monocyte VOCs identification. Multivariance statistical analyses were used for the data evaluation.

Results: Among the tested SPME conditions, the DVB/PDMS fiber, 30 min of incubation and 30 min of adsorption were find to be optimal. Different chemical profiles of monocyte VOCs were revealed depending on the treatment. In total, 189 volatiles were identified by the SPME-GC×GC-TOF MS method. The main differences were identified between the VOC profiles of monocytes treated with ZYM and LPS when compared to those produced by untreated monocytes. Some of the compounds, which relative abundance varied in relation to the treatment were identified as 2-ethyl hexane-1-ol, octanal, nonanal, and decanal. The identification and assessment of the peak areas by selective mass traces revealed higher sensitivity levels (0.1-10 ng) for most of the detected compounds. Linear ranges (R2>0.99) were determined with at least five calibration levels in concentration ranges of 0.0001 - 33.3333 mM. The reproducibility was lower than 10 % RSD. Triplicate analyses of the same sample (technical replicates) provided typical coefficients of variations (CVS) of <20% for the majority of metabolite peaks, which were detected in 50% of all samples. Statistical analyses based on MFA and heat map of detected VOCs highlighted possible sepsis biomarkers.

Conclusion: This work represents a first step for development of robust analytical method aiming at the fast and reliable characterization of sepsis VOC markers.


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LC-MS-based Pharmacokinetics of Insulin Aspart Measured in Individuals with Type 2-Diabetes During Operation Closed-Loop Glucose Control

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Poster #14b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction:
Simultaneous quantification of endogenous and synthetic insulins could benefit metabolic research and clinical practice, but the available ligand-binding immunoassays lack this capacity. Ultra high-performance liquid chromatography coupled to high-resolution mass spectrometry (UHPLC-HRMS) offers a mean to circumvent this analytical shortcoming. Our aim was to establish a UHPLC-HRMS assay to determine pharmacokinetics of two different insulin aspart formulations during closed-loop glucose control in patients with type 2 diabetes.

Methods:
Plasma samples were obtained from a randomized double-blind crossover trial contrasting short-term closed-loop insulin delivery with Fiasp vs. Novorapid (Fiasp and Novorapid, Novo Nordisk Pharma AG) in 15 patients with insulin-treated type 2 diabetes. All patients had residual endogenous insulin productions and had long-acting insulin on board during the experiment. Plasma samples were collected over 10 hours every 15 min for 3h post-meal intake and every 30 min at other times (n = 1000 samples). Insulin quantification was performed using immune-purification (InsuQuant Mass Spectrometric Kit, Thermo Scientific) combined with UHPLC-HRMS (Q Exactive Plus, Thermo). Insulins were enriched from 500 µL of plasma spiked with bovine insulin (internal standard) by using an automated liquid handling system. A pharmacokinetic two-compartment model was used to estimate time-to-peak plasma concentrations (tmax) and metabolic clearance rate (MCR) of insulin aspart.

Results:
Prior measurement of study samples, the approach was validated for human, aspart and glargine insulins. Based on spiking experiments with stripped serum, acceptable inter and intra-assay CVs ≤ 12 % and bias < 18.5 % were obtained between 7.5 - 960 pM for all insulins.
Estimated tmax was 68±22 min and 90±32 min for Fiasp and Novorapid, respectively (mean of the differences = -12±21 min, p=0.097). MCR was 23.3±20.9 ml/kg/min for Fiasp and 20.0±16.1 ml/kg/min for Novorapid (mean of the differences = 3.7±24.2 ml/kg/min, p=0.64). The non-significant differences in pharmacokinetics between the two insulin formulations was in line with the absence of significant closed-loop performance differences (similar glucose control with Fiasp and Novorapid).

Conclusions & Discussion:
We report here for the first time a UHPLC-HRMS- based approach for a pharmacokinetic study in patients with type 2 diabetes who were exposed to two types of insulins (long-acting insulin and insulin aspart). Simultaneous quantification of human and different synthetic insulins by UHPLC-HRMS at high throughput offers new avenues to evaluate and compare different diabetes treatments.


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Performance of Common Methods When Assessing Protein-Binding in Low-Protein and Low-Volume Samples

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Poster #23c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 9:30 for 1 hour in the Exhibit Hall.

BACKGROUND
Assessment of the degree of protein-binding of drugs is highly relevant in drug development, because only the free drug fraction is pharmacologically active in-vivo. The protein-bound drug fraction serves as a depot and influences the pharmacokinetic behavior.
Determination of the degree of protein-binding of drugs is mostly done in plasma and delivers accurate results for systemically acting drugs. However, investigation of the degree of protein-binding for drugs acting in the tissue needs to be performed in the interstitial fluid (ISF) to yield reliable results. ISF is not easily accessible, and with sampling methods like suction blister or open flow micro perfusion (OFM) sample volumes of only a few microliters (up to 50 µL) can be achieved. Therefore, analytical techniques capable of handling low-volume samples of low-protein fluids are required.
Aim of this study was to assess the performance of the common methods ultrafiltration (UF), rapid equilibrium dialysis (RED) and solid phase micro extraction (SPME) when evaluating the degree of protein-binding in low-protein and low-volume samples of artificial ISF and real dermal ISF collected with open flow micro perfusion.
METHODS
The drugs lidocaine, hydrocortisone, amitriptyline, clobetasol propionate, diclofenac were used as test drugs. The degree of protein-binding for each drug was assessed with UF, RED and SPME. First, the protein-binding in human serum was examined to reproduce published data and then the ISF samples were examined. Environmental parameters (temperature and pH) were varied and different drug- and protein-concentrations were used. Quantification of the drugs was done with HPLC-MS/MS.
RESULTS
The determined free drug fractions assessed with UF, RED and SPME in serum were in good agreement with published results. Variation of the temperature within a physiological range (32°C, 37°C, 42°C) had no significant influence on the results. Change of pH (6.9, 7.4 and 7.9) only influenced the degree of protein-binding of lidocaine (pKa: 7.9). Generally, lower protein content led to an increase of the free fraction of the five investigated drugs.
SPME was not applicable with such low-volume samples, as it needs sample volumes of about 800 µL to deliver reproducible results (CV< 5% n=3). Applying UF was not feasible for low-protein samples, because adsorption to the membrane in artificial ISF was significant between 15% and 85%. RED application delivered reproducible results with the studied low-volume and low-protein ISF samples (CV <2% for n=3).
CONCLUSION
RED application was feasible to investigate the degree of protein-binding in low-protein and low-volume ISF samples


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Confident Protein and Peptide Identification with Mass Spectrometry: Understanding and Exploiting Collision Energy Dependence

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Poster #15a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Recently, MS-based proteomics has become a powerful tool in protein identification and characterization. Particularly for applications in a clinical setting where key information is to be obtained from samples of high complexity and variability, keeping up the pace with the ever-growing requirements is only possible via fully exploiting the potential in our instrumentation and data analysis workflows. In this respect, we recognized a lack of studies directly targeted toward achieving optimum proteomics identification and protein sequence coverage in bottom-up experiments.

OBJECTIVES: We want to explore how the choice of collision energy of the peptide MS/MS experiments affects high-level characteristics of results. We map the energy dependence of the confidence in database search identification (e.g., score), of the number of identified peptides/proteins, and of the sequence coverage for several types of instruments and search engines. We investigate the relationship between the optimal experimental settings and analyte characteristics to potentially serve as the basis of more advanced protocols.

METHODS: Tryptic digests of complex standards (HeLa, E. Coli) were subject to nano-HPLC-MS/MS experiments at dozens of different collision energies on Bruker QTOF and Thermo Orbitrap instruments. Spectra were matched against the SwissProt database using the Mascot and Byonic search engines. Further analysis, including comparison of LC-MS/MS runs and a nonlinear fitting of the score vs. collision energy curves, were performed using Scaffold 4 and our in-house developed software “Serac” (Search Engine Results Aggregation and Combination) processing search engine output files.

RESULTS: Our results revealed the complexity of parameter optimization by demonstrating that several peptides show bimodal score vs. energy behavior, due to the interaction of b/y fragment ion abundance patterns with the peptide identification confidence. The optimal collision energy, obtained as the peak positions of fitted Gaussians, follow linear trends with respect to m/z, but structural effects such as presence of mobile protons have significant effect. The importance of optimization is underlined by a 20-40% increase in the number of identified peptides and in the related sequence coverage, as well as a 20-30% increase in identification score, with respect to the factory default settings.

CONCLUSIONS: Our study is the first of its kind to address trends of and effects on collision energy dependence of a peptide identification score on a statistically significant set of peptides. The unprecedented bimodal behavior and the notable increases in score and identification efficiency indicate the usefulness of our studies in both deepening the understanding of proteomics workflows and in fine-tuning them for optimal performance.


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Determination of Biomarkers of Organophosphorus Agent Intoxication by Ion Chromatography and Tandem Mass Spectrometry

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Poster #19d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction
Organophosphorus nerve agents (ONAs) are one of the most toxic compounds that have been applied several times during military clashes and terrorist attacks. In this regard, it is very important to improve and simplify the existing methods for the determination of ONAs intoxication. Timely determination of ONAs markers in people’s urine can save their lives or indicate the degree of exposure to toxic substances. Low molecular weight biomarkers of ONAs are methylphosphonic acid (MPA) and alkyl methylphosphonic acids (AMPAs). MPA is the most stable and long-lived marker of ONAs, however, its detection does not allow to establish the specific type of agent used. AMPAs are less stable, but they can serve as biomarkers of a certain type of ONAs.

Objectives
The aim of the research was to develop a universal approach for the simultaneous accurate determination of the wide range of polar (MPA, EMPA, APAs) and moderately polar nerve agent markers (AMPAs) in urine.

Methods
Ion chromatography (IC) with tandem mass-spectrometry (MS/MS) using ion-exchange solid-phase extraction (SPE), self-made PS-DVB-based anion-exchanger as stationary phase and deuterated internal standards.

Results
For the determination of wide range of alkylphosphonic acids and alkyl methylphosphonic acids in urine, simple and universal IC-MS/MS approach was developed and fully validated. The study of analyte retention on the in house made PS/DVB-based anion-exchange column showed that APAs are mainly retained due to ionic interaction, and AMPAs due to hydrophobic interactions, which allows simultaneous determination of both highly polar compounds and compounds with two different MS instruments and successfully tested on the urine samples from the Biomedical hydrophobic fragments. The developed sample preparation procedure using anion-exchange cartridges for solid-phase extraction provides a high recovery values of analytes and is ideally combined with the further anion-exchange separation. Application of deuterated internal standards and tandem mass spectrometry led to the high reliability, accuracy and sensitivity of APAs and AMPAs determination in urine. To increase reliability, the proposed procedure was validated on Organization for the Prohibition of Chemical Weapons Biomedical Proficiency Test.

Conclusion
Simultaneous determination of APAs and AMPAs allows not only to reveal the fact of organophosphorus agent intoxication, but to establish its type and sometimes origin. From our point of view, the developed IC-MS/MS approach is the most appropriate way to determine a wide range of phosphonic acids without the use of derivatization.

Aknowledgements
This work was supported by the Russian Science Foundation (Grant No. 19-13-00057) for Lomonosov Moscow State University.


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Different Approaches for Vitamin D Determination in Newborns by LC-MS/MS

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Poster #17c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Vitamin D plays a key role in metabolic processes in human body. Despite the growing social awareness, its large deficit is still being observed, which is particularly important in the case of pregnant women. Vitamin D concentration in the fetal period strictly depends on the maternal concentration. Deficiency of this vitamin in the newborn affects a number of diseases, including abnormal development of the bone or immune system. For this reason, preventing deficiency from the first days of life is extremely important.
METHODS: The tested materials were dried blood spots collected from the newborn for routine screening and umbilical cord blood serum. Biological samples were analyzed using liquid chromatography coupled with tandem mass spectrometry. Quantitative analysis was carried out for four vitamin D metabolites, i.e. 25(OH)D3, 3-epi-25(OH)D3, 25(OH)D2 and 24,25(OH)2D3. Application of the above technique was particularly important in the case of umbilical cord serum, because commonly available immunochemical methods give overstated results. Serum was prepared by liquid-liquid extraction, while DBS was extracted with an organic solvent in 96-well plate. For both materials, derivatization using Cookson-type reagent (DAPTAD) was applied.
PRELIMINARY DATA: The purpose of the study was to investigate whether there is a relationship between the concentration of vitamin D metabolites in umbilical cord serum and DBS. Newborns were diversified in terms of the amount of supplementation (different dose for premature babies, different for full-term pregnancy). Despite the correlation between these two materials, deviating values are observed. This may be due to the different effects of postpartum supplementation on the newborn, considering that the material in the form of DBS is collected within 3 days after delivery. The decisive advantage of both test materials is that they give the opportunity to assess the supply for vitamin D without additional harm to the infant.


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Quantitation of 17β-Estradiol and Estrone in Serum by LC-MS/MS

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Poster #23a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction

We developed Certified Reference Material calibrators (CRMs) for quantitation of estradiol and estrone in serum. Calibrators are prepared in SigmatrixUltra™and certified to ISO Guide 34. The matrix is a purified recombinant human albumin (rHSA) solution free of endogenous interferences present in serum. Absence of endogenous interferences supports standardization and accurate measurement of analytes. Five calibrator levels were prepared gravimetrically at concentrations of 1000, 500, 100, 20 and 10 pg/mL in Sigmatrix Ultra™ from Cerilliant CRMs E-060 (Estradiol 1mg/mL) and E-075 (Estrone 1mg/mL). The product was certified by a combination of gravimetric mass measurements and LC-MS/MS analysis.
The LC-MS/MS method was validated and based on a published Primary Reference Measurement procedure.1 The method was used to quantitate estrogens in the CRMs for certification and stability studies. The method uses liquid-liquid extraction with reconstitution such that extract concentration is at the middle of a value assignment curve made in solvent. The extract is analyzed against the value assignment curve to measure concentration of estrogens in CRMs. The method provides accurate quantitation to 10 pg/mL of estradiol and estrone.
Method validation was performed for precision and accuracy across three days. BCR578 and BCR577 were used as higher order controls along with gravimetrically prepared in-house quality controls. Recovery, matrix factors and extract stability were established. Results for precision and accuracy of control samples were ± 10%.
CRMs were used as calibrators to measure the concentration of estrogens in serum samples provided by Center for Disease Control (CDC). This study was undertaken to show that CRMs will perform as calibrators and provide measurement of estrogen concentrations in serum samples. Measured estradiol values using these CRMs were within 10% of the stated values for the samples.

Results
The concentration of estrogens was quantitated in each CRM using a validated method. The accuracy for the lower two CRMs was within ± 15% and within ±10% for the rest of the CRMs. The assay had an analytical measurement range of 10 to 1000 pg/mL. Each CRM had CVs of < 20% and accuracies ranged from 100-113%. The CRMs were able to quantify estradiol in CDC serum samples with an accuracy of 90.9 and a CV of 1.9%.

Conclusion
Matrix based CRMs have been developed, manufactured and certified under ISO17034 and ISO/IEC17025 for quantitation of estradiol and estrone in serum. A sensitive and accurate LC-MS/MS method was developed and validated to support product certification. Stability studies are on-going. SigmatrixUltra™, a recombinant HSA serum diluent, was a reliable alternative to stripped serum as matrix for calibrator preparation. Performance of CRMs was demonstrated by analyzing estradiol in CDC serum samples.


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B Vitamin Reference Ranges Determination Using HPLC-MS/MS and Retrospective Statistical Analysis

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Poster #19e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction

Determination of the correct reference intervals (RIs) is the basis for precise interpretation of the results in routine laboratory testing. The use of RIs established in other laboratories is often incorrect due to different populations and methods. Ideally, each laboratory should have its own RIs, however their determination is very costly for many laboratories. One of the compromise solutions is a retrospective mathematical analysis of routine tests for determining RIs. At present, there is no rigorous mathematical algorithm that would allow the RI to be set retrospectively from the results of routine research: in most methods, the researcher often has to use visual assessment or he faces not always the obvious choice.

Objectives

The objectives were to establish reference ranges for group B vitamins in the Caucasian population in whole blood and plasma using various methods proposed in statistics, evaluation of their advantages and disadvantages and develop clear criteria for choosing a particular method.

Methods

In this study, we have used HPLC/MS/MS method for determining the concentration of vitamins in whole blood and plasma. For retrospective data analysis and establishing reference ranges we have used and compared Bhattacharya, Hoffmann and Mixed Gaussian Models methods.

Results

664 patients were included. We established RIs for Caucasian population. For plasma: vitamin B2 (FAD) 56-97 nmol/l, vitamin B2 (riboflavin) 4-43 nmol/l, vitamin B3 (niacin) 13-161 nmol/l, vitamin B5 (pantothenic acid) 54,5 – 604,4 nmol/l, vitamin B6 (PLP) 11,3- 302 nmol/l, vitamin B7 (biotin) 0,025-5,647 nmol/l. For whole blood: vitamin B1 (TPP) 82 – 239 nmol/l, vitamin B2 (FAD) 116 – 393 nmol/l, vitamin B6 (PLP) 3,5 – 80 nmol/l.

Conclusion

At the moment there is no universal method for determining reference intervals. Depending on the data structure, each method has its own advantages and disadvantages. The most optimal in most cases was the Hoffman method presumably due to the best excluding from a sample people who take B vitamins as dietary supplements.


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Semi-Automated Positive Pressure SPE for Proteomics

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Poster #2b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction
Post-translational protein modifications (PTMs) mediate a wide variety of processes in biological systems such as signal transduction, cell cycle regulation or enzymatic activity and abberant PTM have been connected to numerous pathologies. Mass spectrometry-based PTM analysis usually employs tailored analyte enrichment in conjunction with labor-intensive solid-phase extraction (SPE) procedures for initial and final sample clean-up. The positive pressure SPE (ppSPE) workstation allows for semi-automated SPE resulting in significant reduction of lab-time in comparison to manual SPE using spin tips (3–4 hours instead of 2 days for 100 samples). Here we demonstrate how to exploit the workstation in conjunction with ERLIC-HPLC for highly sensitive detection of protein phosphorlyation events in proteomic samples. This workflow includes (I) SPE of samples after digest (RP - Reversed Phase), (II) enrichment and fractionation of phosphopeptides (HPLC-based ERLIC = Electrostatic Repulsion-Hydrophilic Interaction Chromatography) and (III) SPE of fractions for subsequent nanoLC-MS/MS.

Results
In the first experiment, positive pressure SPE with Cerex WWP2 (C18) columns was systemtically compared to manual SPE using SPEC (C18). Both methods showed excellent recovery rates for desalting HeLa digest in the range of 5–500 μg. Below 5 μg both recovery rates were insufficient.In a second experiment, positive pressure SPE with Oasis HLB μElution plates (Waters) performed excellent for recovery of low abundant p-peptides (in comparison to the manual extraction via spin tips). Notably, the automated buffer exchange via the dispensing function of the positive pressure workstation and the transfer to 96 well plate format critically reduced the sample handling time (3–4 h instead of 2 days for 100 samples).

Conclusions & Discussion
In this work we demonstrate the entire semi-automated workflow of proteomics sample prep from protein precipitation, digestion to buffer exchange and clean up experiments in a 96 well plate format. Reproducible protein loading concentrations range from 30 µg to 200 µg for protein digestion in membrane filter, for desalting of tryptic digested HeLa cells using protein loading concentrations from 5 μg to 500 μg were achieved. Recovery rates and signal intensities of peptides and phosphopeptides are equal compare to manual workflow, however the loss of sample during processing was reduced.


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Methodological Traceability: Standardized Description of LC-MS-based Measurement Methods in Laboratory Medicine

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Poster #11e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

OBJECTIVE: Many detailed guidelines for LC-MS method development are available and well known in the literature. However, the description of the method itself is hardly standardized. Particularly in the field of LC-MS, many variables like different manufacturers and day-to-day or even hour-to-hour variability of instruments have to be considered.
We suggest a standardized approach to the description of LC-MS/MS methods in clinical application as an oral presentation in the Scientific Session 1 (Quality Control) of this conference.
In this concept we suggest differentiating between fundamental and variable characteristics. Fundamental characteristics define the identity of a method and can be standardized between different laboratories and over longer periods: for example, ionization mode (e.g. positive electrospray ionization), main column chemistry like C18 or internal standard compound(s), including labelling pattern. On the other hand, variable characteristics cannot be standardized over time and space: for example, lots of column or solvents, MS instrument manufacturer, as well as ion source geometry or vacuum conditions.
With a companion poster presentation, we aim to exemplify the application of this suggested standard for a representative TDM method.

METHODS: The herein described novel approach was applied for the description of a LC-MS method for the quantification of linezolid in human serum. To highlight the consistency between two different systems across fundamental and variable characteristics, we implemented the method on an Acquity UPLC coupled to a Xevo TQ-S from Waters and an Agilent 1290 Inifnity II coupled to an AB Sciex QTrap 6500+.

CONCLUSION: The suggested approach was found to be a good tool facilitating standardization in the description of LC-MS/MS methods. Notably, variations in fundamental and variable characteristics of both described systems indicate the importance of standardized technical description.


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Development and Validation of a LC-MS/MS-based Assay for Quantification of Polyunsaturated Fatty Acids from Human Plasma and Red Blood Cells

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Poster #9b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Polyunsaturated fatty acids (PUFAs) play essential roles in human physiology. Changes in PUFAs metabolism may have implications in obesity, type 2 diabetes, insulin resistance, cardiovascular diseases, and also interrelationship with other metabolic pathways. Considering their importance, accurate quantification of n-3 and n-6 PUFAs is required.
Until recently, PUFAs were quantified using gas chromatography coupled with mass spectrometry (GC-MS) or flame ionization detector (GC-FID); and by liquid chromatography–mass spectrometry (LC-MS) following derivatization. Chemical derivatization requires additional sample preparation steps, which adds extra-complexity to the method.
OBJECTIVE: As few methods have been developed for the full quantitation of fatty without derivatization, we aimed to develop a method that requires fewer sample preparation steps which can be used for the quantitation of several PUFAs from human plasma and red blood cells.
METHODS: The lipids were extracted from plasma and red blood cell samples. The fatty acids were released by alkaline hydrolysis. In plasma samples, the selected fatty acids were from both free and total forms. Chromatographic separation was achieved using a reversed phase C18 column with isocratic flow using 90% acetonitrile with ammonium acetate. Mass detection was performed in multiple reaction monitoring (MRM) mode, and deuterated internal standards were used for each targeted compound. The targeted fatty acids were: alfa-linolenic, arachidonic, docosahexaenoic, linoleic, and eicosapentaenoic. The method was validated according to the U.S. Department of Health and Human Services guidelines, addressing calibration curve, accuracy, precision, recovery, quality control samples, and sensitivity.
RESULTS: The limits of quantification were situated in the low nanomolar range, excepting linoleic acid, for which the limit was in the high nanomolar range. Elution started at 3.83 min with eicosapentaenoic acid, while the last was linoleic acid at 5.02 min. The HPLC method ended at 6.5 min. All acceptance criteria found in the validation guideline were met.
CONCLUSION:
Since derivatization was not employed, the sample preparation protocol was less time-consuming and labour-intensive. The LC-MS/MS proved significantly faster than previously published GS-MS methods. The proposed method offers a fast, sensitive, and reliable quantification of selected omega 3 and 6 fatty acids in human plasma and red blood cells.

Acknowledgement: This work was performed at The Centre of Genomic Medicine, POSCCE Project, SMIS:48749, and funded by POC Project NutriGen, SMIS:104852.


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Development and Validation of an LC-MS/MS Method for the Measurement of Plasma Tryptophan, Kynurenine, Serotonin and 5-Hydroxyindoleacetic Acid

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Poster #25a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Carcinoid tumours are rare neoplasms arising from the enterochromaffin cells of the neuroendocrine system. Midgut carcinoids are often associated with hyper-secretion of serotonin and can result in carcinoid syndrome; with symptoms including wheezing, diarrhoea and flushing. Measurement of urinary excretion of serotonin metabolite 5-HIAA is widely recommended for both the diagnosis and monitoring of midgut carcinoid tumours. However, collection of 24-hour urine samples can be burdensome, error prone and subject to dietary and medication induced fluctuations. Substitution with a single plasma sample would prove more convenient for patients. Combined measurement of related compounds may also allow a greater understanding of tryptophan metabolism in the carcinoid patient. AIMS: Development of a LC-MS/MS assay for the simultaneous quantification of plasma serotonin, its precursor tryptophan, 5-HIAA and associated compound kynurenine in accordance with CLSI C62A guidelines and establishment of healthy population reference ranges for all analytes. METHOD: Following protein precipitation, chromatographic separation of analytes and their respective deuterated internal standards was achieved following a 10µL injection onto a C18 Fortis column (4.6 x 150mm, 5.0µm). Analysis was carried out using a Waters Acquity® UPLC system coupled to a Xevo TQD® tandem mass spectrometer operating in ESI-positive mode. Multiple reaction monitoring was used to detect analyte and corresponding internal standard transitions. Matrix effects together with assay linearity, imprecision, accuracy, recovery, stability and sensitivity were assessed. Sample comparisons for both 5-HIAA (n=38) and tryptophan (n=12) were carried out using local established assays.
RESULTS: Co-elution of tryptophan, kynurenine, serotonin and 5-HIAA with their deuterated internal standards at respective retention times of 4.93, 4.51, 4.12 and 5.10 minutes was achieved using gradient elution. The assay was linear to 375μmol/L for tryptophan (R2=0.995), 17.5µmol/L for kynurenine (R2=0.999), 12.5µmol/L for serotonin (R2=0.999) and 10µmol/L for 5-HIAA (R2=0.999). Despite profound matrix effects for serotonin and tryptophan (MF 0.1-0.8), the assay was both adequately accurate and precise with inter-assay precision of <10% for all analytes across the working concentration range. Acceptable assay sensitivity was demonstrated with lower limits of the measuring interval defined as 5μmol/L, 250nmol/L, 200nmol/L and 30nmol/L for tryptophan, kynurenine, serotonin and 5-HIAA, respectively. Good correlation (R2=0.99) but a mean difference of 21.9% (95% CI of -59.8-16.1%) was observed between the two 5-HIAA assays. Difference of 33.7% (95% CI of 9.1% to 58.3%) was noted between new tryptophan assay and the referral laboratory method. CONCLUSION: Despite further planned work to reduce impact of endogenous sample matrix, a simple LC-MS/MS method has been developed with potential clinical utility.


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Pharmacometabolomic Study of Novel Multitarget Drugs Based on Natural Prostaglandins in Terms of Therapeutic Effectiveness

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Poster #26a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction. In last few years multi-target drugs have gained high popularity at the drug development market. Its main pharmacological effect is provided by the combined action of hybrid compounds that interact with several targets in the area of one disease. Novel biogenic molecules, prostanit® and nitroproston®, represent an interesting example of multi-target compounds. They are based on natural prostaglandins PGE1 (in prostanit®) and PGE2 (in nitroproston®) linked by a glycerol moiety to two nitric oxide (NO) ‒ donating fragments. Due to biogenic nature of the these pharmaceuticals, as well as rapid integration of their active components into biochemical cycles, metabolism study becomes difficult. To overcome these complexities, metabolomic approaches were used, giving an opportunity to investigate their metabolic pathways, mechanisms of action and therapeutic effectiveness.

Methods. There were conducted in vivo studies randomly assigning the target drugs (treatment groups) or a saline solution without the drug (vehicle control groups) to 12 rabbits (n=6 in each group). Using untargeted (LC-MS-IT-TOF) and targeted (LC-MS/MS) approaches rabbits plasma samples were measured at 10 time-points within 0-60 minutes. Further univariate and multivariate statistical methods were utilized for identification of the metabolites, which concentration levels were induced after drug administration.

Results. The heatmap showed clear discrimination between the vehicle control and treated groups for all found metabolites. Prostanit® and Nitroproston® undergo rapid hydrolysis that results in formation of their two main components: 1,3-dinitro glycerol and Prostglandin E (PGE1 and PGE2, respectively) that are subsequently oxidized to 15-keto-PGE and 13,14-dehydro-15-keto-PGE. We identified that the most significantly changed metabolic pathways, induced after Prostanit® administration were: purine, alanine, glutamate and glutathione metabolism. Moreover, Prostanit® administration activates oxidation processes (e.g. transformation of proline to hydroxyproline). At the same time, Nitroproston® impacted steroidogenesis, purine metabolism and ammonia recycling. Notably, multiple metabolites identified in our study connected to Nitroproston® have been previously considered as having anti-asthma properties (i.e. cortisol, cortisone, aspartate).

Conclusion. To the best of our knowledge this study is the first that describes the metabolic profiles of drugs based on natural prostaglandins. In this study there were presented suggested mechanisms of action and metabolic pathway interactions of drugs based on natural prostaglandins, as well as useful information for further understanding of their metabolic effects and therapeutic effectiveness.


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Data-Independent Acquisition Spiked with QconCAT Quantification Standards (DISQ):An Alternative to Targeted Methods?

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Poster #22d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction

Targeted proteomics by multiple or parallel reaction monitoring (MRM/PRM) is the current gold standard for absolute protein quantification in complex biological samples. Quantification of target proteins is achieved by spiking analyte matrices with heavy-labelled standards in known amounts. However, methods using targeted acquisition require extensive and time-consuming method establishment and the number of target proteins per run is limited.

Recently, data-independent acquisition (DIA) has been established as the new standard for discovery proteomics. Rapid scanning of moving acquisition windows allows for comprehensive analysis of complex biological samples. DIA also enables reproducible and precise protein quantification, due to less missing values compared to standard datadependent acquisition (DDA) approaches. In contrast to DDA mode, eluting peptides are fragmented several times, allowing for quantification on the MS2 level. Standard DIA approaches are restricted to inter-run relative quantification, but do not allow for intra-run absolute quantification.

Objective
We seek to enable absolute quantification of target proteins in DIA approaches by using heavy labeled quantification standards.

Methods
To assess the linearity of target protein quantification and overall analytical depth by DIA, 27 peptides of an artificial protein standard were spiked at increasing concentrations into a HeLa digest. Samples were measured in DIA mode and analyzed for the linearity of target protein signal. In a second experiment, we spiked both labeled and unlabeled artificial protein into a human urine sample to proof the feasibility of intra-run absolute protein quantification.

Results & Discussion
In HeLa digest, we observed a linearity of target peptide intensities over four orders of magnitude. In the same experiment, we identified 5,835 HeLa proteins. In human urine, we were able to precisely quantify the spiked target protein, while identifying 835 human proteins.

Conclusion
Our proof-of-concept study shows that the deep protein coverage of DIA methods can be combined with exact target protein quantification in the same LC-MS/MS run. This opens the potential to quantify a high number of target proteins in complex samples.


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Site-Specific Haptoglobin N-Glycosylation Changes in Colorectal Cancer

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Poster #6a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in Europe in both men and women. Discovering less invasive diagnostic tools is essential for clinical practice, in particular for the early stage detection, but also for patient stratification. Previous studies showed significant changes of total plasma N-glycome in CRC. Assessing the site-specific glycosylation of an isolated carrier protein can provide valuable insights into CRC-associated glycosylation signatures. Previously, it was reported that elevated difucosylation of haptoglobin (Hp) tetraantennary glycans can be used to discriminate between early stage of hepatocellular carcinoma and cirrhosis. Hp is an acute-phase protein which is synthesized in the liver and is one of the major serum glycoproteins. We here present the first large-scale study of Hp glycosylation in CRC.
METHODS: Two different methods were applied on two independent clinical cohorts. A nano-LC-ESI-MS method for glycopeptide analysis of the four glycosylation sites was developed and applied on serum samples from a clinical cohort consisting of 186 CRC cases and 186 presumably healthy controls, in addition to 86 post-surgery CRC patients. To this end, Hp was captured from serum using affinity purification, and digested with trypsin, resulting in the detection of 75 different glycopeptide compositions in total. Data processing and quantification were performed in a semi-automated manner using the in-house built software LaCyTools. The second cohort consisted of 224 CRC cases and 268 healthy controls for which Hp was isolated from plasma followed by N-glycan release by PNGase F and measurement by UPLC with fluorescence detection. Using logistic regression, we tested for associations of glycopeptide features with case-control status.
RESULTS: Our preliminary data indicate that Hp fucosylation and sialylation increase in CRC compared to controls. Site-specific analysis revealed specific alteration in synthesis of tetra-antennary structures, i.e. on asparagine 241.
CONCLUSION: Moreover, the independent on-going replication setup will enable us to validate our findings and to compare two different analytical approaches for N-glycosylation analysis and further assess the potential of Hp glycosylation as a biomarker for patient stratification or disease outcomes in CRC.


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Analysis of Estrone and Estradiol to Low pg/mL Levels in Human Serum by Triple Quadrupole Mass Spectrometry for Clinical Research

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Poster #15c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) has been widely adopted as an analytically sensitive and selective technique for measuring estrone and estradiol in complex matrices such as human blood plasma or serum. Quantitation of these steroids down to low-picogram per milliliter levels are required by many clinical researchers. We endeavored to achieve this using a triple-stage quadrupole mass spectrometer with the most efficient production, isolation and transmission of precursor ions and fastest selective reaction monitoring.

Objective: For detailed studies, scientists need to quantitate ever lower concentrations of estrone and estradiol in serum samples. Here we demonstrate a method capable of detecting low pg/mL of both estrone and estradiol in human serum for clinical research.

Methods: Samples were prepared by liquid-liquid extraction (LLE). Following chromatographic separation by a reversed-phase high performance liquid chromatographic (HPLC) gradient, analytes were detected on a triple quadrupole mass spectrometer. Precision was determined by analyzing replicate concentrations over three days. Accuracy was determined by analyzing Center for Disease Control (CDC) Hormone Standardization (HoSt) Program Phase 1 samples.

Results: Both estrone and estradiol were able to be quantitated down to 2 pg/mL. Inter-assay precisions of replicate samples across the calibration range were better than 8.4%. Accuracy of estradiol analysis was demonstrated using the CDC HoSt samples with 90% of the samples agreeing within 15% of reference values.

Conclusions: We have demonstrated a sensitive, precise and accurate method for the quantitation of estrone and estradiol in human matrix for clinical research. A detection limit of 2 pg/mL with ion ratio confirmation was achieved for both estrone and estradiol using a TSQ Altis triple quadrupole mass spectrometer. Accuracy of the method was demonstrated by analysis of CDC HoSt program Phase 1 samples.


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New Solutions Applied in Oral Fluid Drug Testing: Fine-Tuning and Optimization of the SPME-LC-MS Method

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Poster #28e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction:
Whether ingested, inhaled, injected or otherwise applied, drugs with systemic mechanism of action are at some point present in blood and then in urine, with which they are excreted. And however popular, so called conventional matrices are also troublesome. Collection of blood is invasive, while obtaining urine is either intrusive when performed under supervision or else burdened with high risk of adulteration. Such inconveniences shift interests of doping control and law enforcement towards alternative matrices. Among them, oral fluid (OF) stands out as a direct filtrate of blood, well resembling its composition. Easy to collect in transparent manner, OF offers very promising and reliable opportunity for determination of recent substance use. Solid phase microextraction (SPME) provides sample preparation for optimal testing performance with its economically friendly device reusability, environmentally friendly low organic solvent consumption and user friendly simple protocol. High performance liquid chromatography (HPLC) is already well-established separation method for complex biological samples, while tandem mass spectrometry (MS) grants excellent selectivity and sensitivity as a detection method.
Objectives:
The main objective was to confirm that OF could be introduced as a matrix for routine drug testing with analytical approach based on combining the benefits of SPME and LC-MS methods.
Methods:
Presented method utilized SPME in fiber format (C18 sorbent), reversed phase HPLC (PFP column) and triple quadrupole MS (Shimadzu LCMS-8060). All experiments were performed with OF samples spiked with 46 various drugs from the World Anti-Doping Agency’s (WADA) Prohibited List covering 7 different classes and broad range of proprieties. SPME fibers were evaluated in terms of extraction efficiency and prevalence of carry-over effect. In addition series of comparisons helped establish optimal solvent for sorbent preconditioning, essential parameters of extraction process (agitation rate, pH value) and most fitting desorption solvent. Permission to conduct experiments was given by the local Bioethics Committee.
Results:
Optimized protocol was validated and fully complies with requirements of Food and Drug Administration and WADA. Best results were obtained with SPME preconditioning in acetonitrile/water (50/50, v/v) for 44 of 46 drugs, extraction pH value of 7 for 26 of 46 and desorption to acetonitrile/water/formic acid (80/19,9/0,1) for 25 of 46 in terms of efficiency and 40 of 46 substances for lowest carry-over effect.
Conclusion:
Oral fluid was confirmed as a potential matrix for drug testing and presented SPME-LC-MS method was proved to be suitable for antidoping or forensic applications. In addition, use of only the commercially available materials enables its introduction to everyday laboratory practice.
Acknowledgement:
The authors would like to acknowledge NCRD Poland (grant LIDER/44/0164/L-9/NCBR/2018), Shimpol and Supelco for their support.


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Analyses of Volatile Organic Acids in Exhaled Breath Using Secondary Electrospray Ionization Mass Spectrometry (SESI-MS)

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Poster #16d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction: Human breath is a complex mixture containing endogenous metabolites and exogenous compounds. Carboxylic acids represents an interesting class of metabolites. There are several reports about volatile organic acids related to various diseases; such as hexanoic acid in gastro-esophageal cancer, propanoic acid in lung cancer [1], unsaturated fatty acids in irritable bowel disease and acetic acid in cystic fibrosis [2] with concentration ranging from pptv to ppbv. Secondary electrospray ionization mass spectrometry (SESI-MS) is a highly sensitive real time technique for online analyses of trace amounts of VOCs in exhaled breath.

Objectives: Primary objective of the study is to quantify volatile carboxylic acids concentrations by SESI-MS in exhaled breath and headspace of biological samples.

Methods: To develop SESI-MS quantification, the breath and headspace samples were analysed using SESI-MS and in parallel by real-time quantitative selected ion flow tube mass spectrometry (SIFT-MS) method.

Results: The bespoke SESI ion source was optimized for trace volatile acid analyses. Carboxylic acid were analysed in exhaled breath samples and headspace of biological samples using both SESI-MS and SIFT-MS. The relative ionization sensitivities were thus obtained for a series of volatile carboxylic acids. It was found that for acetic acid the sensitivity was 73000 per ppbv (in the units as given by Excalibur software) in dry air. The range of linearity was up to 200 ppbv. In humid sample corresponding to breath sensitivity decreased to 9800 per ppbv. Similar changes were observed for propionic (dry 706000, humid 4700) and butyric acids (dry 3x10^6, humid 2900) noting that the linearity improved in accord with decreased sensitivity. The trends in variability of sensitivities can be explained by ion-chemistry reactivity schemes.

Conclusion: SESI-MS can be used for quantification of volatile carboxylic acids present amongst metabolites in exhaled breath, serum and other biological samples. The variation in ionization efficiencies is related to proton affinities, dipole moments and gas phase acidities. Humidity plays a major role in actual analytical sensitivity and calibration must consider this.

Acknowledgement: The study was funded from Czech Science Foundation by GACR project 18-12902S “Secondary electrospray ionization mass spectrometry (SESI-MS) for quantification of gaseous analytes in air, headspace and breath”.

References:
1. Queralto N et al 2014 J. Breath Res. 8 027112.
2. Dryahina K et al 2018 J. Breath Res. 12 016002.


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Exploring Healthy and Tumor Tissue Microenvironment with Immuno-Oncology Markers Using Multiplexed Hyperion Imaging System

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Poster #22a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION:
To power immuno-oncology discovery, it is highly beneficial to explore healthy and tumor tissues with immuno-oncology markers using multiplexed analysis. The Hyperion™Imaging System uses novel technology for tissue imaging that enables multiplexed analysis of protein expression in a single tissue sample. This methodology uses tissue sections stained with a cocktail of antigen-specific antibodies conjugated to different metal isotopes. In this study, we demonstrate how to generate high-parameter images with immuno-oncology markers on the Hyperion Imaging System, facilitating Imaging Mass Cytometry™ (IMC™) applications.
OBJECTIVE:
In this study, we demonstrate how to generate high-parameter images with immuno-oncology markers on the Hyperion Imaging System.
METHODS:
The IMC workflow uses immunostained and dried samples of tissue sections (FFPE or cryosections) and/or cells attached to glass slides which are inserted into the ablation chamber of the Hyperion Imaging System which uses a 1um spot-size pulsed UV laser at 200Hz which ablates the tissue. Isotopes associated with each spot are transferred into the mass cytometer, where via ICP-MS TOF, these are detected and indexed against the source location, yielding an intensity map of the target proteins throughout the tissue.
The use of highly pure metal labels on antibodies provides a solution to the current challenges in multiplexed tissue imaging by separating signals based on differences in mass, which overcomes the limitations of fluorescence-based detection modalities.
RESULTS:
Using these optimized staining protocols, we generated images from various normal and tumor tissues to show a combination of 5 structural, 1 cancer, 3 nuclear, and 18 immuno-oncology markers simultaneously. Together with other tissue architectural details, different immune cell types were identified in both normal and tumor tissues. This image resolution allows the visualization of proteins in the membranous, cytoplasmic, and nuclear cell compartments.
CONCLUSION:
The Hyperion Imaging System makes it possible to deeply interrogate tissues and tumors at sub-cellular resolution while preserving the information in tissue architecture and cellular morphology, ideal for characterization of the tissue microenvironment across a breadth of disease research areas, including immune-oncology.


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A Fast and Robust Method for the Quantification of Venetoclax by LC-MS/MS

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Poster #14f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Venetoclax, a BCL-2-inhibitor for the treatment of B-cell lymphoma associated with chromosome 17p deletion, is used more and more in the clinics. Because of severe toxicity, venetoclax has to be titrated at the beginning of the therapy. Further, it is metabolized over CYP3A4 and therefore prone to interactions, which makes therapeutic drug monitoring highly recommended.

Objectives: We aimed to develop a fast, simple and sensitive high-throughput LC-MS/MS method for the analysis of venetoclax in clinical routine.

Methods: 50 µL of plasma were mixed with the precipitation solution including the internal standard (d7-venetoclax) and centrifuged afterwards. The supernatant was transferred into autosampler vials and 20 µL was injected into the LC system using reversed phase chromatography with isocratic conditions. Detection was done by electrospray ionization mass spectrometry in the positive ionization mode. The method has been fully validated according to EMA and US-FDA guidelines.

Results: The method was shown to be linear over the entire calibration range (0.01-5.0 mg/L) with a lower limit of quantification at 0.01 mg/L. For within-day and between-day analysis, the CV's were <4.8% and the accuracy was between 95-98%. The method was demonstrated to be free of matrix effects for serum, heparin-, and EDTA-plasma.

Conclusion: The presented LC-MS/MS method allows a fast, simple and reliable determination of venetoclax.


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Integrated Toxicological Screening and Confirmation Analysis with Stable 24/7 Availability

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Poster #19b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Toxins or poisons are substances which already in small doses may lead to malfunction, damage to health or death. Prompt toxicological analysis may allow early identification of the toxic agent and give therapeutic guidance. In clinical laboratories, screening methods by immunoassays using polyclonal antibodies are commonly applied. Antibody-based screening, however, may cause a relevant number of false positive and false negative results. Detected drugs are not quantified. Furthermore, immunological screening requires a set of 5 to 10 different assays. Nonetheless, comprehensive drug screening and quantification of relevant substances by chromatography with mass spectrometry is often indispensable.
Objectives: To overcome these shortcomings, our aim was the development of a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for a targeted screening of a broad toxicological spectrum with stable 24/7 availability and without need of special skilled personnel. To verify instrument stability, downtimes due do maintenance and service were investigated.
Methods: All relevant compounds from a list of the substances most frequently detected in patient samples addressed to the GIZ-Nord Poison Center at the University Medical Center Goettingen in the years 2014-2018 were selected and integrated into the targeted screening method.
We used a Clinical Laboratory Automated sample preparation Module (CLAM-2030, Shimadzu) connected to an LC-MS/MS system (LCMS-8050, Shimadzu). We reanalyzed routine patient samples and compared results of typical antibody-based screening and our targeted screening method. In addition all samples were analyzed with our untargeted LC-QToF screening method for forensic toxicological purposes. Downtimes, maintenance and service times of the CLAM-2030 and LCMS-8050 will be shown.
Results: We successfully developed a fast and fully automated LC-MS/MS method for the quantitation of 152 relevant toxicological compounds. 100 patient serum samples were investigated and results compared with our routine toxicological screening by LC-QToF. All relevant substances could be identified using the novel LC-MS/MS screening method (triple quad) in comparison with our well established comprehensive screening procedure with LC-QToF. Repeated measurements of quality control samples showed an inaccuracy of less than 20 % for most of the tested substances. Hence, quantification by one-point calibration is well suited for assessing the severity of an intoxication.
Conclusion: We established a fully automated, robust, quantitative screening method for the detection of more than 150 exogenous substances in serum. It allows a targeted toxicological emergency screening in clinical laboratories without LCMS-skilled personnel. To further refine the method, evaluation and interpretation of the results may be improved and automated.


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Probing Aβ Dynamics in APP Knock-In Mice and in vitro Using Stable Isotope Labelling and MALDI Imaging Mass Spectrometry, and Examining the Role of Microglia

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Poster #3d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction
Amyloid beta (Aβ) plaque deposition is a major pathological feature of Alzheimer’s disease (AD); however, this exact process remains unclear. Moreover, the relationship between plaques, soluble Aβ and microglia is controversial.

Objectives:
We aim to assess Aβ deposition and plaque composition in detail both in vivo and in an organotypic hippocampal slice culture (OHSC) model obtained from amyloid precursor protein (APP) knock-in mice (APPNL-F and APPNL-G-F), and also assess the interaction with microglia.

Methods:
OHSCs were made from P5-7 WT and APPNL-G-F mice. For both, plaque pathology was cross-seeded by incubation with exogenous Aβ1-40 and Aβ 1-42, and brain homogenate from older plaque-bearing mice. Aggregation and plaque development in OHSCs were examined after 8-12 weeks in culture.
Further incubation with stable isotope-labelled Aβ was used to label plaques developing in vivo. Specific aggregation dynamics of different amyloid species was analysed from both in vitro and in vivo preparations using matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI-IMS).
The type, number and distance of microglia around plaques will be characterised in different brain regions in APPNL-F and APPNL-G-F mice.

Results:
After 8 weeks in culture, OHSCs developed amyloid deposits, with the type and number depending on the peptide for incubation. MALDI techniques can distinguish between initial Aβ seeds and later deposition depending on application of labelled isotopes, allowing for assessment of the nature in which the plaque grows. MALDI can also be used to delineate Aβ species associated with plaque formation both in vitro and in vivo.


Discussion and Conclusions:
Cultured slices can be manipulated to develop amyloid pathology, making this a useful model for the efficient study of plaque development in mice. Microglia cluster around Aβ plaques which implicates their role in AD pathology.
MALDI allows for high resolution imaging, elucidating details of timing of plaque deposition, and the type and distribution of Aβ peptides in and around the plaque.


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Solid Phase Microextraction (SPME) in Kidney Examination – LC-MS/MS-based Identification of Potentially Significant Metabolites in Graft Quality Assessment

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Poster #20c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction:Transplantation is the treatment associated with increased survival rate and greater quality of patient’s life when compared to conventional dialysis. Even nowadays transplantology suffers from the lack of reliable methods of organ quality assessment. The standard protocols are limited to macroscopic appearance inspection or invasive tissue biopsy which do not provide a comprehensive information about the graft. Kidney is the organ largely associated with metabolic processes, thus measurements of metabolites concentrations may permit determining potential organ quality biomarkers and predicting the graft outcome. Hence, there is a need for new diagnostic solution allowing on site graft monitoring and quick decision-making processes during the surgery.
The goal of the project is to identify metabolites associated with changes occurring in transplanted kidneys during preservation with the use of in vivo and in situ low-invasive solid phase microextraction followed by LC-MS/MS instrumental analysis.
Methods:The study was performed on kidneys harvested from two types of porcine model donors: heart beating donor (HBD) and donor after cardiac death (DCD). Sample collection was performed according to the SPME method with the use of probes coated with 7 mm mixed-mode extraction phase. Sampling was conducted directly from the graft tissue: in vivo before transplantation, in situ after 1h, 3h, 5h, 7h of perfusion, in vivo 3 and 7 days after revascularization in the recipient, and additionally for DCD after 45 min and 2h of warm ischemia time. The untargeted metabolomic analysis was done with the use of liquid chromatography (RPC, HILIC) coupled with high resolution mass spectrometry (Q-Exactive Focus) in both positive and negative ionization modes. The putative identification of detected metabolites was done by comparison of accurate masses with metabolomic databases. In order to confirm identities of metabolites selected as significant ones in organ quality assessment, their retention times and fragmentation pattern were compared with chromatograms and MS/MS spectra of authentic standards.
Results:Monitoring the metabolomic profiles of kidneys allowed to observe biochemical changes occurring in the organ during preservation as well as biochemical differences between HBD and DCD types of donor. Alterations are mostly related to concentrations of metabolites which might be the part of ischemia/reperfusion injury mechanism due to their involvment in i.e. oxidative stress, ischemia and energy metabolism pathways.
Conclusions:SPME is a low-invasive method for direct in vivo kidney extraction without removing any tissue from the graft which makes the method an alternative for biopsy. The small size probe and minimal invasiveness of the approach permits for repeatable samplings from the same organ. Identified metabolites could be considered for further analyses towards decreased organ quality or progressing graft dysfunction biomarker validation.


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Analysis and Characterization Modified in vitro Transcribed RNA Using LC-MS/MS Method

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Poster #14i View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: The stability of mRNA largely depends on the 3’- end and 5’- end structures which are targets for enzymatic degradation. Chemical modifications of those regions are introduced into in vitro transcribed mRNAs in order to confer on them resistance to degradation and increase their translation efficiency, thereby increasing their therapeutic potential. Chemically modified mRNA is a promising therapeutic agent with potential uses in cancer immunotherapy and gene replacement therapy.
Objectives: The primary objective of the study was to develop an LC-MS/MS method to analyze modified in vitro transcribed RNA using triple-quadrupole apparatus with electrospray ion source.
Methods: An LC-MS method for quantitative assessment of incorporation of ATP analogs modified at the α-phosphate and nucleobase into transcripts by RNA polymerases has been developed. Modified RNA was enzymatically degraded into single nucleotides followed by their quantification. To this end, synthetic internal standards labelled with [18O] within phosphate were synthesized. Ion pair chromatography coupled with ESI-QQQ was used for HPLC separation.
Results: We obtained chemically modified in vitro transcribed RNA by replacing standard NTPs with appropriate ATP analogs either containing various O-to-X substitutions, differing in stereochemistry (ATPαX; SP versus RP), or modified within nucleobase. A mixture of modified NTP and unmodified ATP at different ratios was used in the transcription reaction. To assess the efficiency and frequency of incorporation of the modified NTP versus natural NTP, conditions for complete RNA degradation using phosphodiesterase enzyme were determined to obtain exhaustive cleavage into single nucleotides. By using synthesized isotope-labelled nucleotides we were able to quantify modified and unmodified monophosphate adenine nucleotides. Thereby we were able to determine structure of RNA and RNA polymerases specificity.
Conclusions: Proposed LC-MS quantitative method can be use to analyse modifications within naturally occurring RNA and in vitro transcribed RNA thereby providing a tool for establishing RNA structure-biological properties relationship. Acknowledgement: This work is founded by National Science Centre, Preludium (UMO-2016/23/N/ST4/03186.


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Analysis of the Site-Specific N-Glycosylation of HeLa Cell Lysate

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Poster #13e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: The analysis of glycoproteins in biological samples is a challenging task. Routine glycoproteomics approaches involve sample enrichment, proteolytic digestion followed by de-glycosylation, the analysis of components with HPLC-MS/MS and data assessment via database search. However, during de-glycosylation the site-specificity of the information is lost, and during DDA MS/MS analyses many minor components are overlooked.
The use of HeLa cells in cancer research is prevalent and it is also the most commonly used mass spectrometry reference standard for proteomics. Although they have been extensively studied, there is very little information available on protein glycosylation in HeLa cells.

OBJECTIVES: Our aim was the determination of the site-specific N-glycosylation pattern of the proteins in a commercially available HeLa cell lysate.

METHODS: Here we introduce a novel workflow, which combines a glycopeptide enrichment and LC-MS analysis; the latter involving structural analysis using data dependent and energy resolved MS/MS, and quantitative analysis using MS1. This provides both excellent sensitivity, and reliable structure assignments. Our focus was not on maximizing the quantity of the identified glycopeptides, but rather on enhancing the reliability of the results. For this reason, we incorporated a multi-step validation protocol into the data evaluation workflow.

RESULTS: We identified over 40 human glycoproteins, with 69 glycosylation sites, 28 different glycans and altogether 178 glycopeptides with high confidence. Among these we have identified both core- and antenna-fucosylated glycoproteins, complex, high-mannose and hybrid N-glycosylated structures using special low-energy MS/MS experiments. We have also discovered very high amounts of bovine serum protein contaminants in the HeLa cell lysate. This suggests that previous studies – especially released glycan analyses – on HeLa glycosylation may have been biased, as the glycosylation pattern of cellular and serum proteins is different. This presumption is strongly supported by the results of the comparison of our data to a recent study on HeLa glycosylation based on released glycan analysis. [1]

CONCLUSION: The first detailed, protein- and site-specific N-glycosylation analysis of the HeLa cell line is presented. Our data also suggests that HeLa glycosylation should only be studied in a site-specific manner to avoid bias resulting from the presence of the culture media.

ACKNOWLEDGEMENTS, REFERENCES: LT and KV are grateful for funding from the National Research Development and Innovation Office (NKFIH PD-121187 and NKFIH K-119459). LT is grateful for support from the János Bolyai Research Scholarship of the Hungarian Academy of Sciences.
[1]: Gao, Wenjie, et al. "A facile method for cellular N-glycomic profiling by matrix-assisted laser desorption/ionization mass spectrometry." RSC Advances 7.57 (2017): 35687-35693.


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Evaluation of an Artificial Serum as a Surrogate Matrix for Calibration Samples for a Preeclampsia Risk Prediction Test

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Poster #26c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction
A specific challenge of developing LC-MS assays for the quantification of endogenous compounds such as biomarkers, is the choice of a suitable matrix for the preparation of calibrators and QC samples. Ideally, these samples should consist of the authentic biological matrix containing an accurately known concentration of the analyte. For endogenous substances, care should be taken using the authentic biological matrix since it typically contains a baseline concentration of the analyte complicating the preparation of calibrators. Furthermore, the use of the authentic matrix may lead to lot-to-lot variation affecting the manufacturability of calibrators and QC samples. In isotope-dilution mass spectrometry, the use of a surrogate matrix which mimics the authentic biological matrix as much as possible but is analyte-free has been proposed as a means to overcome this challenge (1, 2).

Here we evaluate the suitability of a protein-free substitute for plasma or serum, SeraSub™ (CST Technologies, New York, USA), as a surrogate matrix for the preparation of calibrators for PrePsia™ (Metabolomic Diagnostics, Cork, Ireland). PrePsia™ is a screening test to predict the risk for preterm preeclampsia in early pregnancy involving the analysis of specific metabolite biomarkers employing LC-MS/MS.

Methods
Plasma samples and calibrators were prepared using Stable Isotope Labeled Internal Standards (SIL-ISTD) and protein precipitation. Target endogenous small molecules were analysed by multiplexing ESI-LC-MS/MS assay. The validity of SeraSub™ as a surrogate matrix was evaluated by assessing: (i) levels of endogenous analyte, (ii) linearity in intended calibration interval, (iii) repeatability (% CV), and (iv) matrix effect. Results were compared with BSA 5% in PBS, an established surrogate matrix.

Results
SeraSub™ showed no traces of analytes of interest, whereas for BSA this was highly dependent on the procurement source. Both SeraSub™ and BSA showed comparable linearity in the intended calibration interval (SeraSub™ r2>0.96; BSA r2>0.98; using 7 calibrator levels), and acceptable repeatability for all target metabolites (CV<15% for 6 replicates per calibrator per matrix). Spiking both surrogate matrices and plasma with the SIL-ISTDs chosen for the respective metabolites revealed differential matrix effects.

Conclusion
Our results show that SeraSub™ is a promising alternative surrogate matrix to BSA 5% in PBS for LC-MS assays. However, for commercial assay development, the choice between SeraSub™ and other possible surrogate matrices will also consider further aspects such as price, availability, lot-to-lot variability and long-term stability.

1. van de Merbel NC. TrAC 2008;27(10):924-33.
2. Hess C, Sydow K, Kueting T, et al. Forensic Sci. Int. 2018;283:150-55.

Acknowledgements
This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 789083.



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High-Field Asymmetric Waveform Ion Mobility Spectrometry (FAIMS) - Parallel Reaction Monitoring (PRM) for HER2 Protein Quantitation in Tumor Biopsies

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Poster #26b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction:
Human epidermal growth factor receptor 2 (HER2) over-expression is a driver of breast cancer tumorigenesis in a subset of patients. HER2-positive metastatic breast cancer is treated with anti-HER2 antibodies, such as trastuzumab. In the clinic, HER2-positive is defined as immunohistochemistry (IHC) 3+ or IHC 2+ and FISH-positive. Novel anti-HER2 antibody drug conjugates may be clinically effective even with lower levels of HER2 expression necessitating more sensitive and robust quantification of HER2. Mass spectrometric targeted assays have shown several advantages over IHC assays, including absolute quantitation and enhanced multiplexing. To maximize the sensitivity and the selectivity of a clinical MS assay, we have taken advantage of ion mobility separation of peptides, subsequent to reverse-phase nanoLC separation and prior to separation in the gas-phase. We have developed a targeted HER2 mass spectrometric assay utilizing FAIMS separation, coupled to a high resolution Orbitrap detector, and applied it to FFPE tissue tumor biopsies.
Methods:
The HER2 FAIMS-PRM assay utilized an EvoSep One nanoLC system (EvoSep, Odense, DK) coupled to an Orbitrap Fusion Lumos mass spectrometer with a FAIMS-PRO interface (Thermo Scientific, San Jose, CA). Formalin-fixed HeLa cells and human tissue were used as a complex matrix to determine the limit of detection (LOD) and limit of quantitation (LOQ). A ten-point dilution series was acquired in triplicate, ranging from 5 amol to 100 fmol on-column. Each analysis consisted of 1 µg matrix or sample spiked with stable-isotope labeled internal standard peptide (5 fmol; ELVSEFSR).
Test samples included HER2+ and HER2- FFPE breast cancer samples Tumor-rich regions were collected by laser microdissection using LEICA LMD 6500 (LEICA Biosystems, Germany), and digested with trypsin. PRM data was analyzed using Skyline software version 4.2 (University of Washington, WA).
Results:
The optimal compensation voltage for HER2: ELVSEFSR [M+2H]2+ was -57 V. For the ELVSEFSR peptide, LLOQ changed from 137 amol to 45 amol with ion-trap detection, and improved CV was observed with Orbitrap detection. We demonstrated that this assay allows absolute quantitation of HER2 levels in FFPE tumor samples at attomole levels.
Conclusions:
FAIMS-PRM further improves the conventional PRM performance and offers more sensitive biomarker quantitation in the clinical setting, applicable to HER2 quantitation in FFPE tumor biopsies. We see a peptide-specific range of sensitivity improvement with FAIMS, presumably dependent upon the level of interference without FAIMS and the degree to which FAIMS is able to remove the interfering peaks. This technology will allow us to investigate patient stratification for anti-HER2 therapy below the current IHC 2+/3+ thresholds.


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Tandem Mass Spectrometry-based Analysis Reveal Relationship between Active DNA Demethylation and Krebs Cycle in AML and MDS

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Poster #27g View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: The most dynamic process which regulates DNA methylation is recently discovered active demethylation. It involves ten-eleven translocation (TET) enzymes to catalyze stepwise oxidation of 5-methylcytosine (5-mCyt) to 5-hydroxymethylcytosine (5-hmCyt) and further demethylation products 5-formylcytosine (5-fCyt) and 5-carboxylcytosine (5-caCyt). Mutations targeting TET genes are frequently observed in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Mutations in genes: succinate dehydrogenase (SDH), fumarate hydratase (FH) and isocitrate dehydrogenase (IDH) are also found in acute leukemias. These mutations result in accumulation of the succinate (SA), fumarate (FA), 2-oxoglutarate (2-OG) and R-2-hydroxyglutarate (R-2HG). It may deregulate the activity of TET enzymes and, in turn, DNA demethylation. Although the oncogenic mechanism of these mutations remains still under investigation, determine of these metabolites could be relevant for diagnosis, prognosis and treatment of a subset of patients with AML and MDS.

OBJECTIVES: The main objective of this study is to find out the relationship between the level of 5-mCyt and the derivatives of active DNA demethylation process and the level of metabolites: SA, FA and 2-OG/2-HG in plasma/urine of patients developing AML and MDS.

METHODS: In this study we have examined 3 groups: healthy controls, patients with AML and MDS at diagnosis de novo. In all groups we have measured the level of epigenetic DNA modifications in leukocytes using isotope-dilution automated online two-dimensional ultra-performance liquid chromatography with tandem mass spectrometry (2D-UPLC-MS/MS) and plasma/ urine concentrations of SA, FA and 2-OG using UPLC- MS/MS method. The level of R-2HG in urine and plasma has been measured using 2D-UPLC-MS/MS after derivatization with DATAN (Di-O-acetyl-L-tartaric anhydride).

RESULTS: Our preliminary research has shown two 5-hmCyt subpopulations in AML patient cohorts with higher and lower level of 5-hmCyt compare to healthy controls. Besides, we have observed reverse correlation between global level of 5-hmCyt and 2-hydroxyglutarates. We have noticed a few extreme values of 2-HGs in the urine of patients with AML and MDS. The level of D-2-HG and D/L 2HG ratio are notably increased 10-100-fold in AML (22%) and MDS (10%) patients in urine.
CONCLUSION: These research have shown relationship between the level of the derivates of active DNA demethylation process and metabolites. Larger studies need to be performed to revealed how the concentrations of SA, FA, 2-OG and R-2HG influence key enzymes of active DNA demethylation pathway.


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Development of High Sensitivity Measurement of Arginine Vasopressin in Human Plasma by LC-MS/MS

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Poster #27c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

【Introduction】
Arginine vasopressin (AVP) is a peptide hormone consisting of 9 amino acids secreted from the posterior pituitary. The main physiological functions of AVP are the antidiuretic action and vasoconstrictor action via the renal tubular V2 receptor. AVP is measured to clarify the involvement of AVP secretion in the case of water metabolism disorder and Na metabolism disorder. Conventionally, measurement of human plasma AVP concentration has been performed by radioimmunoassay. However, even now, it is very difficult to measure plasma AVP accurately. In this study, we aimed to develop LC/MS/MS based method to accurately measure endogenous AVP in human plasma.

【Methods】
A 300 µL aliquot of human plasma samples obtained from apparently healthy human subjects were mixed with 270 µL of 4% phosphoric acid aqueous solution and 30 µL of internal standard (IS). The mixture was purified using solid phase extraction (SPE). After evaporation and reconstitution, extracts were analyzed using a AQUITY UPLC I-Class coupled to a Xevo TQ-XS mass spectrometer (Waters Corporation, Milford, MA, USA). The analytical and pre-analytical performances of the LC-MS/MS assay were evaluated by determination of precision, trueness, linearity, possible interferences, and lower limit of quantification. We also tested how the results obtained by our LC/MS/MS compare with those obtained by the conventional RIA (YAMASA CORPORATION, Japan).

【Results】
The lower limits of quantification for AVP was 0.2 pg/mL (%CV<10,%Dev<15,S/N>10). The calibration curves showed good linear response over the concentration range of 0.2-10 pg/mL for human plasma (y=0.9998x+0.0012, R2=1). Imprecision of the assay was very good: within and day to day precision (CVs) were 1.9–6.5% (0.5-9.6pg/mL, N=5) and 3.6 -7.7% (0.5-10.1pg/mL, N=5), respectively. The absolute recoveries of AVP at concentration of 0.5-10pg/mL (N=5) ranged 104-114%. Although the overall correlation between LC/MS/MS (X) and RIA (Y) was seen (Y= 0.458 X+1.0478, r= 0.94, N=32), the results obtained by LC/MS/MS did not agree well with those obtained by the RIA in the low concentration range of 4 pg/mL or less (Y=0.2473X+1.3843, r=0.37).

【Conclusions & Discussion】
We have developed a sensitive, accurate, and precise LC-MS/MS-based method for the quantitation of AVP in plasma samples obtained from healthy subjects. This method will enable the accurate determination of very low-levels of plasma AVP. We are planning to determine plasma AVP by the LC/MS/MS method in the real-world clinical samples obtained from patients with central diabetes insipidus.


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Method Development of Amino Acid Analysis in a Dried Blood Spot for the Second-Tier Test in the Newborn Screening Program

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Poster #10c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: Metabolic disorders are caused by the accumulation of metabolites in the body which lead to irreversible physiological effects. The first-tier screening procedure for these disorders is typically performed on dried blood spot (DBS) samples by the MS/MS system. When a newborn screen is found to be positive, second-tier tests using plasma samples are provided to reduce false-positive and false-negative results. To prevent resampling and provide comfort for newborns, it is more convenient to use the same DBS sample taken in the first stage of screening. Objective: The objective of this study was development of a method based on the DBS instead of plasma analyses for each aminoacidemia disorder that could potentially use as second-tier tests. Methods: To optimize the extraction conditions of 19 naturally occurring amino acids from DBS, the central composite design and response surface methodology were used to demonstrate the influence of effective factors on the responses. Also, four different types of validation were compared, and the best validation method was selected.
Results: The best conditions for extraction of each amino acid related to the PKU and MSUD biomarkers were selected based on the response surface equations. Then the effect of the actual sample matrix and extraction efficiency on the responses have been measured based on the slop ratio of four different calibration curves. By comparison of their slop ratios, matrix free calibration method has been selected to continue the study. The intra- and inter-day precisions of all amino acids were below 11%. Mean recoveries from spiked DBS samples were among 78% and 111%. The lower limit of detection and lower limit of quantification for all amino acids were obtained between 0.02-0.10 and 0.06-0.33 µmol/L respectively. The biomarkers of PKU and MSUD were quantified among 148 participants. Finally, the results of HPLC-PDA with MS/MS as NBS standard protocol has compared and a good correlation between the results has been observed.
Conclusion: The study results provide evidence that the optimized methods are reliable not only as second-tier tests but also as affected children’s follow-up methods.


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Simultaneous Determination of 14 Antiretroviral Drugs in Plasma by micro-LC-MS/MS for Therapeutic Drug Monitoring

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Poster #8d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction
The development of combination antiretroviral (ARV) therapy had a major impact on survival rate and quality of life of HIV-infected patients. The long-term drug regimens raise some specific issues, among other adherence, virus resistance, and associated metabolic syndrome. In order to improve the treatment, these patients need close clinical and laboratory evaluations, including therapeutic drug monitoring (TDM).
Objective
The aim of our study was to develop a novel method for simultaneously determination of 14 ARV drugs currently used in our hospital (atazanavir, darunavir, lopinavir, ritonavir, abacavir, emtricitabine, lamivudine, zidovudine, raltegravir, dolutegravir, efavirenz, nevirapine, etravirine and maraviroc) in plasma samples of treated patients by micro-liquid-chromatography coupled with mass spectrometry (micro-LC-MS/MS).
Methods
Quantitative determination of ARVs was performed in Multiple Reaction Monitoring, positive electrospray ionization, using deuterated analogues as internal standards. Analytes were isolated from biological samples by protein precipitation. Because of the very different polarity of the target analytes, the chromatographic separation was challenging, and after testing several stationary phases, a PFP (50x0.5 mm, 2.7 μm, 90A) column was selected. Calibration curves were built in plasma enriched with analyzed drugs at different concentrations, according to their pharmacokinetics. The overall range was from 1 to 15000 ng/mL. Quality control (QC) samples were prepared at 4 concentrations (3xLLOQ, 2 mid-range QCs and 1 high-range). Method was validated according to guidelines, for selectivity, linearity, accuracy, precision, samples stability. The clinical samples were collected with informed consent from 50 HIV positive patients of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals”.
Results
Calibration curves with correlation coefficients >0.995 were obtained for all analytes. Adequate accuracy (85-115%) was also obtained, with good precision (within-run and between-run CVs <10%) in the whole measured range for most analytes, except zidovudine (CV>15% at low concentrations due to sensitivity issues). Maraviroc, efavirenz, atazanavir and raltegravir also showed higher imprecision (CVs 10-15%).
The plasma samples from 50 treated patients were collected before ARV administration (for Cthrough), but also at 2, 4 and 8 hours after administration. ARVs concentrations showed great variability among patients with the same therapy regimen. Adherence could be estimated by examining similar TDM results for the same patient in different sampling days. Three of the patients had no plasma concentrations of ARVs in the collected samples and were considered non-adherent.
Conclusion
The new method was applied in our hospital for monitoring patients with long therapeutic experience and multi-drug resistance. TDM results, together with viral load and resistance data were used for the therapeutic decisions.


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Direct Quantification of Amino Acids in Human Plasma by LC-MS/MS

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Poster #8c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction:
Amino acids are the building blocks of proteins and intermediaries to many biochemical pathways. They play an important role in biochemical regulation, and any abnormalities in abundance may be indicative of greater metabolic issues or inherited disorders. This analysis is expected to include a large panel of compounds run in a single method. The main approaches have consisted of LC-UV analysis using derivatization of the compounds or HPLC-MS/MS analysis, either using an ion pairing agent for the retention of the compounds or through derivatization. Here we present a novel workflow that simplifies sample preparation by eliminating the use of a derivatization reagent to detect 52 L-amino acids in human plasma with excellent reproducibility in 18 minutes.
Methods:
Plasma samples (100 µL) were protein precipitated and diluted with an internal standard solution prior to injection onto an LC-MS/MS triple quadrupole mass spectrometer. Separation of compounds was performed with an 18-minute aqueous/organic gradient based on mixed mode chromatography. Calibration solutions were prepared in water with eight calibration levels ranging from 0.1 to 500 µM. The LOQ for each amino acid was set to the lowest calibration standard analyzed that yielded < 20 % inaccuracy and < 20% CV for 10 replicate injections of the same standard. For 27 compounds, it was possible to perform an analytical validation based on the use of external quality controls from ERNDIM (http://www.erndim.org). Accuracy and precision for intraday and interday assays were therefore assessed with 30 repeated injections and for 30 days accordingly.
Results:
Preliminary data were collected with the use of a Thermo Scientific™ TSQ Endura™ MS and processed using Thermo Scientific TraceFinder™ 4.1 software. Internal calibration was used for 37 compounds, with 25 using the corresponding isotopically labeled internal standards. External calibration was used for five additional analytes. Qualitative detection was achieved for the remaining compounds. The obtained results show accuracy and precision within the limit of 20% for the two quality controls in plasma for the 27 studied compounds, which confirms the possibility to use this quantitation approach for plasma samples.
Conclusions:
The elimination of derivatization simplifies the sample preparation and increases overall throughput with shorter preparation and analysis time and also minimizes the need for costly reagents. Further method development and analysis will be performed on the Thermo Scientific™ TSQ Quantis™ MS to determine the LOQs for all 52 L-amino acids in the panel. Some preliminary work has also been performed for the application of the same protocol in urine, cerebrospinal fluid and dried blood spots. The lack of quality control on these matrices makes it necessary to evaluate the method with a correlation study.
For Research Use Only. Not for use in diagnostic procedures.


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Fully-Automated LC-MS Method for Uracil and Dihydrouracil in Human Plasma

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Poster #14d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Fluoropyrimidines (5-fluorouracil or capecitabine) are anticancer drugs that can lead to severe or lethal toxicities in case of dihydropyrimidine dehydrogenase (DPD) deficiency. In France, health authorities recommend the determination of uracil concentration to guide dosing of fluoropyrimidines. Numerous LC-MS/MS methods have been proposed but they include complex liquid-liquid or solid-phase extraction procedures.
OBJECTIVES: To answer to the need of high throughput analysis our objective was to develop a method where the extraction was carried out by a programable liquid handler directly coupled to a LC-MS/MS system.
METHODS: The extraction procedure was performed by CLAM-2030 coupled to a LCMS-8060 triple quadrupole mass spectrometer (Shimadzu Corporation, Kyoto) used in positive electrospray ionization mode. Acquisition method targeted MRM transitions for uracil, dihydrouracil, uracil-13C,15N2 and dihydrouracil-13C,15N2. The method was fully validated according to the International Standards Organization (ISO) 15189 standard (repeatability, reproducibility, recovery, matrix effect and selectivity). The whole procedure was applied to 50 real patient samples and its results were compared to a validated LC-MS/MS method used in routine at the Limoges University Hospital.
RESULTS: Once on board, 20 µL of plasma were automatically delivered to a tube containing a PTFE (polytetrafluoroethylene) filter, to which reagents were added, mixed and then filtered. About 24 minutes were needed to obtain the first result and then, extraction (10 min) and separation (14 min) were performed in parallel with the system producing a result every 14 minutes. A lower limit of quantitation of 5 ng/ml was easily reach for both uracil and dihydrouracil (DPD deficiency being diagnosed for uracil >16 ng/ml). The procedure was successfully validated and agreement was obtained with the previously validated method used in Limoges (R²> 0.9; n=50).
CONCLUSION: We propose a LC-MS/MS method for the measurements of uracil and dihydrouracil with no human intervention once primary tube is on board. The simplicity of operation and the minimization of user involvement in the sample preparation process will help obtain high throughput for the monitoring of 5-fluorouracil and capecitabine treatements.


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Development of a Sensitive Mass Spectrometric Method for the Quantification of Procalcitonin

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Poster #20d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Introduction:
Procalcitonin(PCT) is employed as a specific biomarker for the diagnosis and monitoring of bacterial sepsis. To this day, the quantification of PCT is almost exclusively performed with immunological methods. Current LC-MS methods do not provide the necessary sensitivity to compete with these methods. Mass spectrometric methods can provide deeper insights into the PCT levels during sepsis.

Objectives:
The primary objective of the current project is the development and application of LC-MS/MS-based methods for the quantification of PCT in human blood using MRM-methodologies. An immune-based enrichment can provide the necessary increase in sensitivity to compete/verify with the established pure antibody-based methods. This method should perform comparable or better to current immuno-logical methods in terms of sensitivity and ruggedness.

Methods:
Recombinant PCT underwent a bead-based immuno-enrichment. Afterwards, PCT was released and cleaved into peptides by proteolytic cleavage. Trypsin, Chymo-trypsin, Asp-N, Glu-C and Thermolysin have been investigated for proteolysis. As an alternative workflow, on-bead digestion was considered. The absence of remaining PCT on the beads was controlled via western blot while the digestion kinetics were monitored with MALDI-TOF-MS (Autoflex Speed [Bruker, Billerica, USA]). The final quantification was carried out on an LC-MS/MS system (QTRAP 5500 LC-MS/MS system [AB Sciex, Redwood City, USA]).

Results:
Several proteases have been investigated, most promising results were obtained with trypsin. An LC-MS/MS method for PCT tryptic peptide and a western blot protocol for detection of PCT have been developed. Western blot will be used as an orthogonal method to support further LC-MS/MS method development. On-going work focusses on comparing different protocols for immune-affinity enrichment and PCT digestions. The immunoenrichment proved to lower the LLOQ in human serum by a factor of 15 to 5 ng/mL. Interestingly, trypsin digestion of PCT did show unexpected kinetic behavior in the processing of a tryptic PCT peptide. After an initial increase of the product concentration, no further digest could be observed after 5-10 min.

Conclusion:
PCT analysis at endogenous PCT levels is challenging and extensive method development is required. A combined Immunoenrichment-LC-MS/MS method has been developed with an LLOQ of 5 ng/mL. Further work is on-going to increase the sensitivity and the enrichment factor.


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Incorporating Stable Isotope-Labeled IgG Internal Standard and Affinity Purification for Analyzing Human IgG4 and Fc-glycan Profiles by UHPLC-MS/MS

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Poster #28b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION:
It is reported that IgG Fc-glycosylation is distinct between patients with autoimmune pancreatitis (AIP) and pancreatic ductal adenocarcinoma (PDAC), which has the potential to be used to benefit differential diagnosis in clinical application.
OBJECTIVES:
Since type I AIP is categorized as IgG4 related disease (IgG4-RD), we aimed to purify IgG4 from human serum and focused on analyzing the Fc-glycosylation profiles. The purification of IgG4 can also solve the issue of isobaric Fc-glycopeptides from human IgG3 and IgG4 of Asia population.
METHODS:
IgG4 affinity beads were used to purify IgG4 from 10 μL of human serum. The incubation time for purification is 0.5 hr, and the on-bead digestion at 37℃ was conducted for 16 hr to get IgG4 representative peptide and glycopeptides from the Fc region. Stable isotope-labeled IgG internal standard (IS) was added before affinity purification which can correct the variation of purification and tryptic digestion efficiently. The targets were analyzed by using UHPLC-MS/MS with multiple reaction monitoring (MRM) mode.
RESULTS:
The concentration range for calibration curve was 0.14-8.8 μg/μL with an r-value of 0.999. The inter-day and intra-day precision of peak area ratios of IgG4 peptide to IS were less than 4.8 % RSD for LLOQ, low, medium and high QC samples. The inter-day and intra-day accuracies were between 95.7-101.8 % for the 4 concentration levels. Matrix effects for low, medium and high QC samples were 105.8-118.9 %. The target peptide was stable in the matrix (chicken serum) for 15 days in -80 ℃ and the recoveries for three freeze-thaw cycles were 85.3-93.7 %. The prepared samples were also stable in autosampler for 24 hr with the temperature set at 4 ℃. The developed and validated method was also applied to clinical samples from patients with AIP and PDAC, and the profiles were compared in this study.
CONCLUSION:
IgG4 quantification and the monitoring of Fc-glycan profiles can be achieved efficiently by using UHPLC-MS/MS with MRM mode. And the developed workflow is suitable for clinical applications.


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Impact of Oral Cleansing Strategies on Exhaled Volatile Organic Compound Levels

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Poster #4a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction
The analysis of volatile organic compounds (VOC) within exhaled breath offers a non-invasive method for the detection and surveillance of human disease. Oral microbial fermentation produces volatile sulphur and fatty acid metabolites. [1-4] Oral contamination of exhaled breath may influence the detection of systemic VOCs relevant to human disease. This study aims to assess oral contamination and cleansing methods in order to standardise practice for breath sampling.

Methods
Ten healthy volunteers consumed an oral nutrient challenge followed by four oral cleansing methods (i) water (ii) salt water (iii) toothbrushing and (iv) alcohol free mouthwash. Direct breath sampling was performed on the selected ion flow tube – mass spectrometry after each intervention. One target ion was used for identification and quantification of compounds. Volatile fatty acid, alcohol, aldehyde, phenol and sulphur metabolites were analysed in parts per billion by volume. Friedman’s statistical analysis was performed (p<0.05).

Results
Volatile fatty acid and alcohol levels (butanoic acid, p<0.001; pentanoic acid, p<0.001; ethanol, p=0.003) declined with oral cleansing interventions, predominantly after an oral rinse with water. Aldehydes and phenol levels (acetaldehyde, p=0.009; menthone, p=<0.001; p-cresol, p<0.001) declined with oral water rinse, however levels significantly increased after toothbrushing and mouthwash use, secondary to flavoured ingredients within the products. No significant reductions were observed with sulphur compounds. Acetone concentrations remained consistent (p=0.988).

Conclusion
Findings suggest that oral rinsing with water prior to breath sampling may reduce oral contamination of VOC levels, and further interventions for oral decontamination with flavoured products may falsify results. This intervention may serve as a simple and inexpensive method of standardisation within breath research.

References

1. Snel, J., et al., Volatile sulphur compounds in morning breath of human volunteers. Arch Oral Biol, 2011. 56(1): p. 29-34.
2. Porter SR, S.C., Oral malodour (halitosis). BMJ, 2006. 333(7569): p. 632-5.
3. van den Velde, S., et al., Halitosis associated volatiles in breath of healthy subjects. J Chromatogr B Analyt Technol Biomed Life Sci, 2007. 853(1-2): p. 54-61.
4. Scully, C. and J. Greenman, Halitology (breath odour: aetiopathogenesis and management). Oral Dis, 2012. 18(4): p. 333-45.


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Attempt to Develop a Fast LC-MS/MS Application for the Simultaneous Measurement of 12 Biogenic Monoamines

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Poster #20j View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Correct measurement of biogenic monoamines is essential in the clinical diagnosis and follow-up of pheochromocytoma, paraganglioma and carcinoid tumours. Currently we measure the catecholamines (adrenaline (A), noradrenaline (NA), dopamine(D)), their metabolites (vanillylmandelic acid (VMA) and homovanillic acid (HVA)) and the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) with two different fluorometric methods, while the metanephrines (metanephrine (MN), normetanephrine (NMN), 3-methoxytyramine (3MT) are measured with an electrochemical detection method. These three methods lack analytical specificity and sensitivity and are time consuming.
OBJECTIVES: To develop a fast, sensitive and specific LC-MS/MS assay for the simultaneous measurement of 12 biogenic monoamines.
METHODS: Optimal mass transitions (parent, quantifier and qualifier) and source settings for each of the 12 biogenic monoamines (tryptophan (TP), 5-HTP (5-hydroxytryptophan), 5-HT (5-hydroxytryptamin), 5-HIAA, A, NA, D, VMA, HVA, MN, NMN, 3-MT) were determined on a Shimadzu XR, LC-MS/MS 8060. For chromatographic separation a mixture of these 12 biogenic monoamines, an ACE C18-pentafluorophenyl column (2 µm, 150x3,0 mm), mobile phase A (2 mM ammonium formate in water with 0,05% formic acid) and mobile phase B (2 mM ammonium formate in acetonitril with 0,05% formic acid) were used. Percentages of mobile phase A and B, flow and temperature were varied to optimize separation. Weak anion exchange (WAX) and weak cation exchange (WCX) columns (Phenomenex and Waters) were used to study recovery of the compounds dissolved in water.
RESULTS: Mass transitions (parent>quantifier>qualifier) were optimized for TP (205.15>188.05>146.10), 5-HTP (221.10>204.15>162,10), 5-HT (176.90>160,20>115.10), 5-HIAA (192.00>146.20>91.30), A (184.00>166.15>107.00), NA (170.00>107.10>77.50), D (154.00>91.05>65.00), VMA (197.10>137.00>108.00), HVA (180.95>122.20>105,20), MN (198.20>148.30>165.30), NMN (166.20>79.30>77.30) and 3-MT (168.20>91.30>151.30). All 12 compounds were chromatographically separated with a minimal resolution of 1.2 when chromatography was started with 3% mobile phase B, increased to 11,5% during 4 minutes, and maintained for 4.5 minutes at 27,5%. The column was cleaned by 2,5 minutes 85% and 4 minutes 3% mobile phase B. Flow was 0,4 ml/min and column temperature was 30°C. Ionization proved optimal with 3 ml/min drying gas, 17 ml/min heating gas, 2 ml/min nebulizing gas, 300°C DL temperature, 400°C interface temperature, 500°C heating block and 2 kV interface voltage. Basic compounds showed acceptable recovery (30-98%) with WCX columns, whereas acidic compounds showed only recovery (10-118%) with WAX column.
CONCLUSION: The developed application is able to specifically measure 12 biogenic monoamines in less than 10 minutes. However basic and acidic compounds require separate sample preparation. Whether analytical sensitivity is sufficient remains to be determined.


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The Hurdles of Developing an LC-MS/MS Assay for Desmosine, a Biomarker for Elastin Degradation

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Poster #24a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be presented and discussed on Wednesday at 12:30 for 15 minutes in De Anza 2 (right outside Exhibit Hall doors across from Ionpath in Booth 36).

Desmosine is a promising biomarker for estimating elastin degradation activity in diseases like chronic obstructive pulmonary disease and cystic fibrosis and for monitoring the effect of therapeutic interventions. We successfully developed an LC-MS/MS assay for the measurement of desmosine in urine and plasma, but encountered numerous obstacles during the developmental and validation process.
These varied from corrosion issues during sample preparation negatively impacting MS performance, to discontinuation of critical SPE material by the manufacturer and wrongful designation of the desmosine standard concentration by its supplier. As Molière stated “The greater the obstacle, the more glory in overcoming it.”


Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by the degradation of elastin, the major insoluble protein of lung tissues. Its degradation gives rise to desmosine (DES) and isodesmosine (IDS) in body fluids. DES and IDS are promising biomarkers for estimating activity of elastin degradation, although their clinical validity and utility remain uncertain due to the lack of reliable and sensitive
assays. The objective of this study was to develop and validate a stable isotope dilution LC-MS/MS method for measurement of DES and IDS in urine and plasma. What was not anticipated were the many hurdles in the developmental process taking years for the assay could be introduced in daily practice.

Methods: The method is based on spiking with a isotope-labeled desmosine standard (D4-DES) to urine or plasma sample, acid hydrolysis (o/n at 110 °C), SPE using cellulose, C18 chromatography using 5mM NH4COOH in H2O/MeOH+ 0,1% HFBA and positive ESI MS/MS analysis (Xevo TQS, Waters) by SRM monitoring of transition ions 526-481 for DES, 526-397 for IDS and 530-486 for D4-DES. Lower limit of quantitation (LLOQ), imprecision profile, linearity and recovery were established.

Results: During assay development, we encountered numerous obstacles varying from corrosion issues during sample preparation negatively impacting MS performance, to discontinuation of critical SPE material by the manufacturer. We managed to obtain a sensitive (LLOQ 0.1 ng/ml) assay with base-line separation of DES and IDS. Intra- and inter-assay imprecision were <10%, assay linearity was up to 10 ng/ml, and DES and IDS recoveries were within 80-120%. We were surprised to observe a two-fold difference in measured concentrations when compared to data obtained from literature. It ultimately proved traced to an error in designation of the desmosine standard concentration by the supplier.

Conclusion: We have successfully developed a sensitive and specific assay for the measurement of DES and IDS in human urine and plasma. This method can be used to assess the potential of DES and IDS as biomarkers for estimating disease activity in COPD and the effect of therapeutic interventions.


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Advancement of the Quantitative Measurement of Enzyme Activities in Six Lysosomal Storage Disorders via LC-MSMS

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Poster #26f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Since treatment advances for lysosomal storage disorders (LSDs), the application of mass spectrometry (MS) techniques have expanded to screening for some of the treatable LSDs. To date, flow injection MS (FI-MS) is generally the preferred screening technique to be of diagnostic value for 6 LSDs, namely Pompe, MPS-I, Fabry, Gaucher, Niemann-Pick A/B and Krabbe disorders, from a single dried blood spot (DBS) sample. We evaluated the analytical performance and diagnostic precision of a 6-plex LSD enzyme assay utilizing the technique of liquid chromatography with tandem MS (LC-MS/MS) within the clinical laboratory setting.
Methods: The LC-MS/MS method is intended for quantitative measurement of 6 individual LSD associated enzymatic products. Quality control (QC) DBS samples were obtained from the Centers for Disease Control and Prevention (CDC) and the Perkin Elmer NeoLSD MSMS kit. The selected QC samples are associated with a range of enzyme product concentrations that span the medical decision limit (MDL) and normal range as best possible. Enzyme activities are obtained by measuring the products formed when enzymes react with synthesized substrates to create specific products. Detection of the enzyme products was performed with an Agilent 6470 Triple Quadrupole LC-MS/MS equipped with an Agilent JetStream technology ESI source (operated in positive ion mode). Chromatographic separation was achieved using a reverse-phase C18 column and a gradient flow rate of 0.40 mL/min. Dynamic multiple reaction monitoring over an 8 minute run time was performed. In addition, an FI-MS method was implemented for comparison to the LC-MS/MS method. The analytical MS methods have been evaluating by linearity, linear range and precision.
Results: Compared to the FI-MS method, the LC-MS/MS method was generally found to be more linear (e.g. LC-MS/MS R2 0.99 – 0.97 vs FI-MS R2 0.97 – 0.85) with a wider linear range for all analytes of interest. Taking CVs into account, near the MDL, the LC-MS/MS method was overall more precise (e.g. LC-MS/MS CV 2% – 16% vs FI-MS CV 2% – 44%) than the FI-MS method. The LC-MS/MS method repeatedly showed comparable results to other laboratories in the CDC proficiency scheme. In addition, two metabolites were observed with the same transitions, but different retention times, than two of the target LSD enzymatic products. This may result in an over-estimation of enzyme products, specifically when reporting enzyme activity for Gaucher and Krabbe disease without applying LC.
Conclusion: We report an LC-MS/MS method for the analysis of 6 LSD enzymatic products, in a single DBS. Emphasized are the advantages of LC-MS/MS, including high selectivity leading to precise quantification of enzyme products and subsequent enzyme activity. This improved method displays good analytical performance and meets clinical laboratory requirements. In summary, the LC-MS/MS method is proposed as an alternative to the standard FI-MS procedure.


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Intact-Cell Mass Spectrometry for Monitoring of Stem Cells Cultures

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Poster #10a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction
Stem cells are capable of self-renewal and differentiation to somatic cell types. Since the derivation of human embryonic stem cells (hESCs), enormous potential for biomedicine has been recognized. hESCs possess immense differentiation potential, and hence they are inherently prone to respond to various stimuli. This cellular plasticity can results in hazardous phenotypic instability and represents one of major biosafety obstacles in the development of bio-industrial or clinical-grade stem cell cultures. Therefore, there is an ongoing need for novel robust, feasible, and sensitive methods for determining status of otherwise identical cells, and for revealing hidden divergences from their optimal states. Here we modeled phenotypic changes in stem cells using different strategies and addressed changes in cell status by optimized intact-cell mass spectrometry (MS).
Methods
hESCs were cultured under identical conditions and processed immediately for intact-cell MS. Cells were washed in phosphate-buffered saline, counted, resuspended in the isotonic ammonium bicarbonate buffer, mixed with an acidified matrix containing sinapinic and 2,2,2-trifluoroacetic acid, and applied to a target plate. The mass spectra were recorded in linear positive ion mode over the 2,000–20,000 m/z range. Data sets were exported in ASCII. The final normalized spectral dataset containing selected m/z values with assigned peak intensities was subjected to statistical analyses.
Results
We compared mass spectra of hESCs cultured for varying time that developed distinct karyotypic or molecular traits. The final normalized spectral dataset was subjected to statistical analyses. Using PCA, the correctly clustered populations corresponding to short and long time of culture were clearly identified. Next, we monitored shifts in the hESC phenotypes after induction of differentiation towards early lung progenitors (ELEPs). Mass spectra recorded from stimulated and control cells reflecting the metabolomic profile between 2000-20000 Da allowed discrimination by cluster analysis, and monitoring of the differentiation process. In summary, the MS approach can therefore discriminate unapparent but potentially hazardous alterations that are not detected by other techniques, or track the proper differentiation route.
Conclusion
The quality of stem cell cultures is an essential prerequisite for clinical applications in which the product variability, batch consistency, or phenotype stability are significant. Here we show that intact-cell MS is capable to distinguish stem cell types in various scenarios. Analysis of spectral fingerprints allow discrimination of otherwise identical cells and provide an elegant tool for quality control of hESCs cultures.
Supported by Ministry of Health of the Czech Republic, grant numbers: NV18-08-00299 and 16-31501A (Ministry of Health of the Czech Republic, all rights reserved) and MUNI/A/1565/2018 (Faculty of Medicine, Masaryk University).


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MALDI-TOF MSI of MeLiM Melanoma: Searching for Differences in Protein Profiles

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Poster #13f View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction: Treatment of advanced cutaneous melanoma remains challenging, and new data on melanoma biology are required. The most widely accepted criteria for the prognostic evaluation of melanoma are histopathological and clinical parameters, and the identification of additional tumor markers is thus of paramount importance. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI), an important tool in cancer research, is useful for unraveling the molecular profile of melanoma.

Objectives: In this report, we used the melanoma-bearing Libechov minipig (MeLiM), a unique animal model that allows observation of the complete spontaneous regression of invasive cutaneous melanoma, to investigate i) the differences between melanoma and healthy skin protein profiles and ii) the proteins potentially involved in spontaneous regression.

Methods: The MeLiM tissues were cryosected, histologically characterized, analyzed by MALDI MSI, and immunohistologically stained. Multivariate statistical analyses of the MALDI MSI data revealed ten relevant m/z ions, of which the expression levels varied significantly among the studied MeLiM tissues. These ion peaks were used to create mass ion images/maps and visualize the differences between tumor and healthy skin specimens, as well as among histologically characterized tissue regions.

Results: Protein profiles comprising ten statistically significant mass ion peaks useful for differentiating cutaneous melanoma and healthy skin tissues were determined. Peaks at m/z 3044, 6011, 6140 and 10180 were overexpressed in melanoma compared with healthy skin tissue. More specifically, m/z 6140 was expressed at significantly (p < 0.05) higher levels in normally growing melanoma regions than in regions with early and late spontaneous regression.

Conclusion: This study demonstrates the clinical utility of MALDI MSI for the analysis of tissue cryosections at a molecular level.


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Fast Multiplexed Analysis of Cannabinoids and their Metabolites in Urine Using MassHunter StreamSelect LC-MS System

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Poster #11c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction

Liquid chromatography triple quadrupole mass spectrometry (LC/MS/MS) is the ideal solution for the simultaneous analysis of multiple cannabinoids and metabolites due to the high specificity and sensitivity of the instrumentation. A chromatographic method was developed to separate following analytes - cannabidiol (CBD), cannabidiolic acid (CBDA), cannabinol (CBN), tetrahydrocannabinol (THC), nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH), 11-hydroxy-Δ9-tetrahydrocannabinol (THC-OH) - using an Agilent 1290 Infinity II Liquid Chromatograph. Quantitative data was acquired using an Agilent's 6470 triple quadrupole mass spectrometer. Sample throughput was nearly quadrupled (3.7x) by running four simultaneous, staggered chromatographic analyses on a single mass spectrometer using Agilent's MassHunter StreamSelect LC-MS software.


Method

Instrumentation includes an Agilent 6470 Triple Quadrupole LC/MS with Agilent JetStream (AJS), four 1290 Infinity II High Speed Pumps, four 1290 Infinity II Multicolumn Thermostats, and a StreamSelect RSI (PAL3) Autosampler. A 4.4 minute gradient (water:methanol, 0.01% formic acid, 5mM ammonium formate) with a 1.6 minute equilibration was run on an Agilent Poroshell 120 EC-C18 column. Quantitation was performed with optimized MRM transition pairs for each analyte and internal standard in positive mode. Urine was spiked with 6 cannabinoids and serially diluted to get calibration curve, (range 5 - 5000 ng/mL). A batch of 1000 identical samples were made at 100 ng/mL. Calibrators and samples were diluted 1:10 with 70% methanol containing labeled internal standards at 50 ng/mL.


Results

A 1/x weighting factor was applied during linear regression of the calibration curves. The quantitation using chromatographic peak area ratio to a known concentration of the internal standards. Each analyte was quantitated with its own deuterated internal standard, expect for CBDA, which was quantitated with CBD-d3. Samples and calibrators were grouped and quantitated based on the stream on which they were acquired. All calibration curves displayed excellent linearity. Retention time reproducibility between all four chromatographic streams was between 0.43% and 1.54% (n = 1000), depending on the analyte. StreamSelect acquired data for 894 samples over a period of 24-hours, which equates to 97 seconds per analysis. Compared to a 6-minute runtime for the same analysis using traditional LC-MS, this results in a 3.7x increase in sample throughput. Over the course of nearly 27 hours, 1000 identical urine samples containing 100 ng/mL of each of the six analytes and their respective internal standards were run across the four LC streams. Quantitative reproducibility was consistent across all streams. Quantitative CVs ranged from 0.47 to 2.79 %.


Novel Aspect

Full, robust chromatographic separation and LC/MS analysis of 6 cannabinoids at a rate of 97 second per sample.


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Graft Quality Assessment in Kidney Transplantation by Monitoring Lipidomic Changes in the Organ During Transplantation Using Solid Phase Microextraction (SPME)

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Poster #21c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction:Transplantology is one of the fastest growing area of medicine. However, it faces many serious problems, such as lack of effective tools for organ quality assessment. Since tissue biopsy is invasive and macroscopic visual assessment is unreliable, new technologies are strongly needed. A lipidomic approach is a possibility to better understanding the mechanism of reperfusion grafts injury and identify potential organ quality biomarkers.
Methods:Solid phase microextraction (SPME) was used for direct kidney sampling and as a sample preparation method. The study was performed on kidneys from two types of porcine model donors (n=6): heart beating donor (HBD) and donor after cardiac death (DCD). Sampling was performed as follow: in vivo before transplantation, in situ after 1h, 3h, 5h, 7h of perfusion, in vivo immediately after revascularization in the recipient, and additionally for DCD after 45 min and 2h of warm ischemia time. Chromatographic separation was done on RP and HILIC columns followed by detection on high resolution mass spectrometer (HRMS) operated in positive ionization mode. The statistical analysis was used to differentiate changes during organ preservation and to find dysregulated lipids, which could be potential biomarkers for organ injury.

Results:One-way Analysis of Variance (ANOVA) and post-hoc analyses were used for the comparison of the study groups. Statistically significant compounds were selected with p-value threshold 0,05. PCA and OPLS-DA plots were created in addition to ANOVA and post-hoc analyses. The results obtained from instrumental analysis together with biostatistical-based approach showed differentiation between samples harvested before and after transplantation. Results of unsupervised analysis indicated the difference in lipidomic profile between monitored time points e.g. HBD donor and reperfusion time point with PC1 describing 54% of the variation and PC2 describing 15.9%. Over 60 statistically significant features were identified for this comparison with the use of volcano plot (p<0.05, fold change>2). Moreover, lipidomic profiling demonstrated changes occurring in kidney grafts during preservation in lipid species form several classes including: PC,PA, PE and LPE.

Conclusions:The obtained results indicated that metabolites related to lipid metabolism may be of high importance in the study of ischemia/reperfusion grafts injury. The observed lipidomic alterations should be confirmed in further experiments to be considered as potential biomarkers. The results demonstrated that low invasive SPME tissue sampling, so called “chemical biopsy”, may provide adjunct diagnostic tool to standard protocol of graft quality assessment in the future.

Acknowledgment:The study was supported by grant Opus 2017/27/B/NZ5/01013 from National Science Centre. The authors would like to thank Supelco Inc. (Sigma-Aldrich Co.LLC) for SPME probes and Thermo Fisher Scientific for the access to Q-Exactive Focus orbitrap mass spectrometer.


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Simultaneous Determination of Vitamins B1, B2 and B6 in Whole Blood by LC-MSMS

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Poster #3b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction:
The clinical manifestations of vitamin B deficiencies can involve alterations of the skin, neurological diseases and various forms of anemia. Accurate diagnosis and treatment of the underlying disease requires an analytical method which facilitates the simultaneous quantification of the most critical B vitamins in a single assay.
Analytical challenges arise from the complexity of whole blood as a sample matrix, the chemical diversity of the B vitamins, and the requirement for a highly selective method that reliably quantifies the biologically active forms of each vitamin.

Objectives:
a) Develop a method for the simultaneous quantification of vitamin B1 (thiamine diphosphate TDP), vitamin B2 (flavin adenine dinucleotide FAD) and vitamin B6 (pyridoxal phosphate PLP and pyridoxal PL) in human whole blood using liquid chromatography and tandem mass spectrometry.
b) Determine analytical figures of merit on two analytical platforms.

Methods:
The analytical method for the quantification of Vitamin B1, B2 and B6 in human whole blood was based on protein precipitation followed by direct injection of the supernatant. Analyte separation was achieved on a reversed-phase-type column using a binary gradient (total run time: 6 minutes). Analytes were ionized in positive mode and detected by multiple reaction monitoring (MRM).
Quantification was based on stable isotope-labeled internal standards and 4 levels of whole blood matrix calibrators.
Method performance was evaluated using the ClinMass® LC-MS/MS Complete Kit for the Determination of Vitamin B1, B2 and B6 in Whole Blood (RECIPE Chemicals + Instruments GmbH, Munich, Germany).
The method was first implemented on a Waters Acquity LC system connected to a Xevo TQ-S triple quadrupole mass spectrometer (Waters, Eschborn, Germany) for research use only. It was then verified on a Xevo TQ-D triple quadrupole instrument (Waters, Germany).

Results:
Fast processing of the samples was required due to the limited stability of B vitamins in biological matrix. Protein precipitation followed by mixing and centrifugation yielded a supernatant suitable for direct injection into the LC-MS/MS system.
Conclusion: The method facilitates the simultaneous determination of members of the B vitamin complex from 50 microliters of whole blood. It meets research laboratory requirements in terms of precision, accuracy, linear range and detection limits.


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Phospholipid Removal from Protein Precipitated Plasma Using In-Line Sample Preparation (ILSP)

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Poster #22b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

INTRODUCTION: Phospholipids are major constituents of plasma membranes and have been shown to cause severe ion suppression or enhancement in the analysis of biological samples by liquid chromatography with electrospray ionization mass spectrometry (LC-ESI-MS). Additionally, phospholipids tend to accumulate on reversed-phase columns, causing a decrease in column performance and reduced life time.
OBJECTIVE: In this study we have developed an innovative inline sample preparation (ILSP) technique to remove phospholipids from protein precipitated plasma samples.
METHODS: Protein precipitation of human plasma was performed by adding acetonitrile containing 1% formic acid to blank or fortified plasma in a (3:1) ratio, respectively. After vortexing for 30 seconds at 3000 rpm, samples were centrifuged for 10 min at 4000 rpm/10°C. All data was collected on a Shimadzu Nexera UHPLC equipped with an additional binary pump and 6-port switching valve. Analysis was conducted using a 5x2.1 mm ILSP cartridge followed by a Raptor Biphenyl 2.7 µm, 100 x 2.1 mm analytical column. Phospholipids and target analytes were monitored in SIM and scan modes using a Shimadzu 2020 MS with electrospray ionization in positive ion mode.
RESULTS: Accurately timed valve switching is critical for a successful inline phospholipid removal method to facilitate washing of phospholipids from the ILSP cartridge while maintaining target analytes. Timing is dependent on the degree of phospholipid retention on the ILSP cartridge in conjunction with the hydrophilic or hydrophobic properties of the analytes. Once the timing of the valve switch is determined, an analytical column is added and the gradient is optimized for speed. For initial experiments, the Raptor Biphenyl 2.7 µm, 100 x 2.1 mm column was chosen. The time program was optimized to allow for simultaneous flushing of phospholipids from the ILSP cartridge, while gradient analysis proceeds on the analytical column. The final analysis with phospholipid removal was completed in <7 minutes. Utilizing this method, lifetime of the ILSP cartridge was demonstrated by successfully performing 500 consecutive injections of protein precipitated fortified human plasma with consistent analyte response (≤2.2% RSD) and retention time (≤0.24% RSD).
CONCLUSIONS: Phospholipid removal by ILSP results in very clean sample extracts and improved signal to noise. A comparison study was performed where plasma samples were fortified with ketoprofen, sulfadiazine, amphetamine methadone, nortriptyline, and prednisolone. Samples were extracted using 36 wells of a representative 96-well plate offline phospholipid removal product and compared to 36 ILSP injections following protein precipitation. Average analyte signal to noise ratios increased by 15 – 189% on average for the ILSP technique, with the exception of amphetamine, which showed a marginal decreased of 23%.


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LC-MS/MS Analysis of Plasma Metanephrines Free of Interference from Midodrine and Metformin

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Poster #23e View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Plasma metanephrines are recommended as one of the first line biochemical tests for the diagnosis of phaeochromocytomas and paragangliomas. LC-MS/MS methods are typically less susceptible to analytical interference than other methods, such as HPLC. However, analytical interference from midodrine, a sympathomimetic, and metformin, has been reported in LC-MS/MS assays for plasma metanephrines, affecting the ability to accurately quantitate metanephrine. We report an LC-MS/MS method for plasma metanephrines that has been demonstrated to be free of interference from midodrine, its metabolite, desglymidodrine, and from metformin.
METHODS: Metanephrine analysis was performed on a Waters Xevo TQ-XS in ESI positive mode following offline solid-phase extraction and separation on a Waters ACQUITY HILIC UPLC BEH Amide column. Separate plasma pools were spiked with known concentrations of midodrine and desglymidodrine and analysed in triplicate. Mean metanephrine (MN), normetanephrine (NMN) and 3-methoxytyramine (3-MT) concentrations were compared to mean results from triplicate analysis of the original plasma pool. Recovery of metanephrines was calculated in order to assess the interaction of the pro-drug and metabolite with the quantitation of metanephrines. Patient samples known to contain metformin were also analysed with an additional MRM transition (130.1>70.9) to detect the presence of metformin and determine the effect on the ionisation of metanephrine.
RESULTS: Averaged recovery of MN, NMN and 3-MT at each midodrine spike concentration were as follows; 105.1%, 98.5% and 101.7% (8.5 nmol/L), 103.8%, 100.4% and 101.2% (17 nmol/L) and 100.6%, 100.0% and 100.8% (34 nmol/L). Averaged recovery of MN, NMN and 3-MT at each desglymidodrine concentration were as follows; 99.0%, 100.2% and 103.7% (6.25 nmol/L), 99.0%, 100.5% and 100.9% (12.5 nmol/L) and 98.3%, 99.3% and 102.1% (25 nmol/L). Analysis of plasma from patients on metformin treatment demonstrated a peak in the 130.1>70.9 transition that was resolved from MN, NMN and 3-MT peaks, eluting at 3.19 minutes.
CONCLUSION: Midodrine and metformin are treatments used for patient groups in which plasma metanephrine analysis may be used in the investigation of orthostatic hypotension and hypertension, respectively. The LC-MS/MS method described has been shown to be free of interference from midodrine, desglymidodrine and metformin, permitting the accurate determination of metanephrine, normetanephrine and 3-methoxytyramine in patients on these medications.


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Modelling the Within- and Between-run Variation in Internal Standard Signal to More Accurately Assess Ion Suppression Effects

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Poster #8a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Background:
Ion suppression and enhancement are commonly encountered issues with the use of electrospray ionisation (ESI) techniques. Determining which samples suffer from these issues is critically important in a clinical environment in order to avoid factitiously inaccurate results. Despite this, determining what constitutes significant ion suppression or enhancement is marred by the fact that internal standard (IS) signal may vary linearly over the course of an analytical run due to normal variation in the ESI plume’s intensity. As such, typical approaches that employ fixed thresholds that ignore a sample’s position in an analytical run may lead to both false positives and negatives. To overcome this, we applied robust linear mixed-effects models to capture the within- and between-run variability in IS signal in order to generate parametric quality control (QC) ranges for routine use.

Methods:
Fifty-nine analytical runs of an in-house LC-MS/MS assay for 25-hydroxyvitamin D3 and D2 were retrospectively collected. Each run consisted of 85 samples (excluding calibrators and QC material). The variation in the percentage deviation of the internal standard area from the mean of the calibrators was modelled through the use of robust linear mixed-effects models in the R statistical computing environment.

Results:
Two models were fitted to the data, one for each compound measured in the assay (25-hydroxyvitamin D3 and D2). The models were fitted with the “robustlmm” R package and revealed that the majority of total variance could be attributed to sample-specific deviations in IS signal (64.3% and 70.8% for D3 and D2, respectively). The remainder of the variance could be attributed to differences in mean IS deviation between runs (35.7% and 29.2%). The models demonstrated a significant positive drift in IS signal over the analytical runs, with coefficients of 0.120 (95% CI: 0.096, 0.143) and 0.228 (0.199, 0.257) for D3 and D2, respectively.

Conclusions:
Here, we have described the application of robust linear mixed-effects models to extensively characterise the variation in IS signal both within- and between-runs in a routinely performed LC-MS/MS assay. These models allowed us to better capture the variation in IS signal as a function of sample position in the run. Taken together, this approach facilitates more robust QC assessment of ion suppression effects in routine clinical practice and therefore improves patient safety. Importantly, this approach is applicable to other MS-based assays that make use of ESI.


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Impact of Body Mass Index on Cytochrome P450 3A Phenotype in Obese Patients

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Poster #26d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Background
Cytochrome P450 (CYP) 3A4 is abundantly expressed in human liver and small intestine, and is generally regarded as the most important enzyme in drug metabolism. There is a large interindividual variability in CYP3A phenotype (CYP3A4 and CYP3A5) and high body mass index (BMI) is associated with low CYP3A4 expression in both the liver and the small intestine. The aim of this study was to characterize and compare CYP3A phenotype, measured as cholesterol-adjusted plasma levels of 4β-hydroxycholesterol (4βOHC), over time in obese patients initiating a low and very low calorie diet.
Material and methods
Plasma samples from 40 obese patients initiating a 9-week low and very low calorie diet were included in the study. 4βOHC was measured by ultra-performance liquid chromatography-tandem mass spectrometry in samples collected at baseline and after 1, 2, 4, 12 and 24 months. Cholesterol levels and BMI were retrieved from the study database. Wilcoxon signed rank tests were used to compare paired 4βOHC to cholesterol ratios (4βOHC/C) between the different time points.
Results
The median BMI at baseline was 40.3 kg/m2 (range 34.9-58.1 kg/m2). Baseline 4βOHC/C ranged >5-fold (1.8-9.5), with a median value of 4.9, and was significantly lower compared to the medians at the five follow-up time points (median 5.6, 6.7, 7.2, 7.3 and 6.5 after 1, 2, 4, 12 and 24 months, respectively, P<0.01). Median 4βOHC/C after 1 month was also significantly lower compared to the medians at the follow-up time points (P<0.02), except for after 24 months (P>0.4). There were no significant changes in 4βOHC/C between the four last time points (P>0.3). The observed changes in 4βOHC/C were inversely related to changes in BMI.
Conclusions
CYP3A activity increased in obese patients after initiation of a low and very low calorie diet, and the changes were inversely related to the corresponding changes in BMI. Clinically, this may be of importance for obese patients initiating BMI-changing interventions during treatment with CYP3A-metabolised drugs.


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A Liquid Chromatography Tandem-Mass Spectrometry Method for Determination of 9 steroids in Human Serum for Diagnosis of CAH and Steroidogenic Biosynthesis Defects

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Poster #27h View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Congenital adrenal hyperplasia (CAH), is a disorder which affects the function of adrenal glands in producing one or more of the steroid hormones. The commonest causes of CAH are the 21-hydroxylase deficiency (95%) and other rarer forms such as 11-beta hydroxylase deficiency. The analysis of 17-hydroxyprogesterone, androstenedione and cortisol is the best screening test for CAH, while the analysis of corticosterone, 11-deoxycortisol, 21-deoxycortisol, 11-deoxycorticosterone, progesterone and testosterone can either be the adjunct to evaluation of 21-hydroxylase deficiency or the evaluation of defects of adrenal steroid biosynthesis.

OBJECTIVES: The primary objective of this study was to develop a LC-MS/MS method for these 8 steroids.

METHODS: A sensitive and selective analytical method was developed and validated for the determination of 17-hydroxyprogesterone, androstenedione, cortisol, corticosterone, 11-deoxycortisol, 21-deoxycortisol,11-deoxycorticosterone, progesterone and testosterone in human serum. Protein precipitation and liquid-liquid extraction was used for sample preparation, followed by liquid chromatography-electrospray ionization-tandem mass spectrometry (Agilent 1290 Infinity LC System and Agilent 6490 Triple Quadrupole Mass Spectrometer). Steroids were separated on an Agilent ZORBAX SB-C18 LC column (2.1mm × 50mm × 1.8µm) with the mobile phase: water (with 2% methanol and 0.2% formic acid): methanol (53:47, v/v, initial ratio) at a flow rate of 0.475 mL/min.

RESULTS: The method was validated for accuracy (<15%), precision (<12.5%), carryover (<5%), linearity (R2>0.99), recovery (80.09-103.27%), matrix effect and stability.

CONCLUSION: This validated method for the 9 above mentioned steroids was deemed fit for purpose to be routinely used as part of the diagnostic investigation of CAH and other steroid disorders.


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Serum Biomarkers of Chemoradiosensitivity in Esophageal Cancer is Identified by the Targeted Metabolomics Approach

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Poster #9d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

Aim: To identify the serum metabolomics signature that is correlated with the chemoradiosensitivity of esophageal squamous cell carcinoma (ESCC).
Materials & Methods: Untargeted and targeted metabolomics analysis of serum samples from 26 ESCC patients, which were collected before the neoadjuvant chemoradiotherapy, were performed.
Results: On receiving the results of untargeted metabolomics analysis, we performed the targeted metabolomics analysis of the 6 metabolites (arabitol, betaine, glycine, L-serine, L-arginine, and L-aspartate). The serum levels of the 4 metabolites (arabitol, glycine, L-serine, and L-arginine) were significantly lower in the patients who achieved pathological complete response with neoadjuvant chemoradiotherapy compared with the patients who did not achieve pathological complete response (p=0.0086, 0.0345, 0.0106, and 0.0373, respectively).
Conclusion: The serum levels of metabolites might be useful for predicting the chemoradiosensitivity of ESCC patients.


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Peptide Sequencing with Top-Down Synthesized TiO2 Nanowires Using Laser Desorption/Ionization Time-of-Flight Mass Spectrometry

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Poster #17b View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 15:30 for 1 hour in the Exhibit Hall.

Introduction : Peptide sequencing in mass spectrometry generally followed through tandem mass spectrometry with the collision-induced dissociation (CID) process, which uses accelerated noble gases for fragmentation. However, peptide sequencing with CID process is inadequate due to the requirement of expensive instrument and expert technicians. Recently titanium oxide (TiO2) nanowires for laser desorption/ionization time-of-flight mass spectrometry (LDI-TOF MS) was introduced with less background noises on low mass region. Moreover, its photocatalytic activity with UV due to the high band gap energy takes attention as a multifunctional solid matrix system.
Objective : Objective of this study is utilizing top-down synthesized TiO2 nanowires for both photocatalytic platform and matrix for LDI-TOF MS.
Methods : Top-down processed TiO2 nanowires were synthesized by modified wet-corrosion process with strong alkali treatment, mild agitation in DW, and heat treatment. Characterization change on surface morphology, phase transition, and photocatalytic activity for synthesized TiO2 nanowires was conducted on each step of processing. Peptide sequencing on six different peptide samples demonstrated by two steps; UV treatment of peptide samples on synthesized TiO2 nanowires by photocatalytic decomposition and LDI-TOF MS for fragment detection.
Results : Surface morphology of synthesized TiO2 nanowires was observed by scanning electron microscope (SEM) and atomic force microscope (AFM). Crystal structure of synthesized TiO2 nanowires was identified as the mixture of anatase and lepidocrocite phases by X-ray diffraction (XRD). The photocatalytic activity of synthesized TiO2 nanowires demonstrated with methylene blue reaction by comparing the commercial TiO2 nanoparticles (P25). Six peptide samples were analyzed to obtain the serial fragment sequences. Three peptides (9, 13, 15 amino acids, respectively.) were analyzed and expected ion forms were suggested. Total serial fragments are observed so the identification on full sequence of parent peptide enabled. Three peptides in identical molecular weights with different amino acid sequences were designed to estimate the performance of synthesized TiO2 nanowire platform. Entire sequence of target peptides was fully distinguished from each and the other by gathering multiple mass spectra results into single screen.
Conclusion : Sequencing six different peptides was conducted through a top-down synthesized TiO2 nanowire solid matrix with LDI-TOF MS after simple UV treatment. Mass peaks from several sample spectra combined and the complete amino acid sequences obtained. Moreover, peptides with identical molecular weights can be distinguished by proposed method.


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Establishment of a Liquid-Chromatography Tandem Mass-Spectrometry Method for Vitamin D Metabolites to Detect 24-Hydroxylase Deficiency

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Poster #13d View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 12:00 for 1 hour in the Exhibit Hall.

INTRODUCTION: Most clinical laboratories measure total 25-hydroxy vitamin D by immunoassays with variable analytical performance. Other relevant metabolites, such as 25-hydroxy vitamin D2 (25(OH)D2), 24,25-dihydroxyvitamin D3 (24,25(OH)2D3) and 25,26-dihydroxyvitamin D3 (25,26(OH)2D3) may provide additional information beyond the simple measurement of 25(OH)D. Liquid-chromatography tandem mass-spectrometry (LC-MS/MS) allows the simultaneous measurement of multiple vitamin D metabolites with high sensitivity and specificity.
OBJECTIVES: Hence, we established an in-house LC-MS/MS method, for the determination of 25(OH)D3, 25(OH)D2, 24,25(OH)2D3 and 25,26(OH)2D3 in order to detect individuals with 24-hydroxylase deficiency.
METHODS: Our method is based on the derivatization with 4-Phenyl-1,2,4-triazole-3,5-dione (PTAD) after protein precipitation and liquid-liquid-extraction. Chromatographic separation was performed on an Agilent HPLC 1260 system using a Zorbax C18Eclipse column and a gradient method with 2 mobile phases. The eluate was introduced into a Sciex 4500 MS/MS instrument for the detection of all four metabolites with a run time of 18 min.
This method was assessed by linearity, limit of detection (LOD), limit of quantification (LOQ), imprecision and recovery. Accuracy was analyzed by method comparison and the reliability of this method was evaluated in four patients, which were referred to our laboratory.
RESULTS: The analytical performance of our new method showed the following results: the within- and between-run precisions ranged between 1.8 and 10.4% and were within the acceptance criteria of <15 %. The LOD was 1.5 nmol/L for 25(OH)D3, and 0.3 nmol/L for 25(OH)2, 24,25(OH)2D3 and 25,26(OH)2D3. The LOQ was 3.1 nmol/L for 25(OH)D3, and 1.0 nmol/L for 25(OH)2, 24,25(OH)2D3 and 25,26(OH)2D3, respectively. In all four subjects a total 25(OH)D (=25(OH)D3 + 25(OH)D2) serum concentration of >100 nmol/L was measured. One subject had distinct lower 24,25(OH)2D3 and 25,26(OH)D3 concentrations of 0.16 nmol/L and 2.35 nmol/L, respectively. Subsequent sequencing of the 24-hydroxylase gene (CYP 24A1) confirmed an inactivating mutation.
CONCLUSION: Our in-house method showed a good and reliable analytical performance for all four tested vitamin D metabolites. Additionally, the establishment of this vitamin D assay enabled to detect a defect of the CYP24A1 gene coding for 24-hydroxylase, which was confirmed with CYP24A1 sequencing.


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Accuracy and Variability of Serum Bioavailable Testosterone Testing Methods

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Poster #28a View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Wednesday at 10:00 for 1 hour in the Exhibit Hall.

Introduction: Bioavailable testosterone (BioT) includes free and albumin-bound testosterone. Total testosterone (TT) can be measured by immunoassays and LC-MS/MS, a preferred method for women and children. BioT can be calculated using various algorithms based on TT, SHBG, and albumin concentrations or measured after removal of SHBG-bound testosterone by NH4SO4 precipitation. We compared BioT results generated by different in-house approaches with a reference lab method.
Methods: TT in 49 sera was measured by in-house LC-MS/MS, electrochemiluminescence immunoassay (ECLIA), and radioimmunoassay (RIA), respectively. SHBG was also measured by ECLIA. Fixed concentration of 43 g/L was used for albumin. BioT was calculated using four algorithms (Vermeulen, Sodergard, Emadi-Konjin, and Morris) based on TT measured by LC-MS/MS and ECLIA, SHBG, and albumin concentrations. For testosterone measured by RIA, NH4SO4 precipitation was performed. BioT values were compared with the reference lab results calculated by a proprietary algorithm using TT measured by LC-MS/MS. Deming regression was performed for method comparison and Microsoft Excel was employed for calculating means and standard deviations (SD) of percent bias. The allowable total error was ±25%.
Results: Method comparison statistics were generated for in-house LC-MS/MS (YL) and ECLIA (YE) calculated with 4 algorithms as well as NH4SO4 precipitation (YP) method compared to the reference lab (X). For LC-MS/MS, Vermeulen (YL1): YL1=0.835X–3.46 (R=0.997), mean bias=-21.1%±9.1% (mean±SD) ; Sodergard (YL2): YL2=1.078X-6.0 (R=0.996), mean bias=13.0%±14.4%; Emadi-Konjin (YL3): YL3=0.430 X-6.29 (R=0.973), mean bias=-68.5% ± 8.0%; Morris (YL4): YL4=0.540 X-4.02 (R=0.969), mean bias=-23.3%±28.8%. For ECLIA, Vermeulen (YE1): YE 1=0.798X–1.58 (R=0.9936), mean bias=-15.8% ±31.5%; Sodergard (YE2): YE2=1.034 X-5.87 (R = 0.9921), mean bias=19.4%±46.4%; Emadi-Konjin (YE 3): YE3=0.405X–3.65 (R=0.972), mean bias=-66.2%±13.0%; Morris (YE4): YE4=0.518 X–7.59 (R=0.9655), mean bias=-23.6%±34.6%. NH4SO4 precipitation (YP): YP=0.883X-10.93 (R=0.988), mean bias=-28.9% ±12.6%.
Conclusion: Compared to the reference lab BioT and based on the in-house LC-MS/MS TT, Vermeulen, Sodergard, and Morris algorithms generate values with acceptable average biases, and the Vermeulen and Sodergard algorithms have correlation coefficients >0.99. Additionally, the least variable methods are Vermeulen and Emadi-Konjin algorithms with a percent bias SD of 9.1% and 8.0%, respectively. Similarly, based on the in-house ECLIA, Vermeulen, Sodergard, and Morris algorithms also produce values with acceptable average biases, and the Vermeulen and Sodergard algorithms show correlation coefficients >0.99. However, in comparison with LC-MS/MS, BioT results calculated using ECLIA TT values demonstrate larger variability in biases compared to the reference lab BioT for all 4 algorithms. Therefore, we select the Vermeulen algorithm and LC-MS/MS TT method for calculating BioT.


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Analysis of Changes in Bile Acids Concentration in Bile in Response to the Degree of Liver Ischemia and the Method of Organ Preservation

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Poster #22c View Map
* Posters are up for the entire congress (Tue PM - Thu). *
This poster will be attended on Thursday at 09:30 for 1 hour in the Exhibit Hall.

Introduction: Liver transplant surgery is currently the standard of treatment in patients with end-stage organ failure. Nowadays, the dominant method of organ preservation used by most transplantation centers is the static cold storage (SCS). However, a better method of organ preservation is sought, which would allow extending the storage time of the graft while maintaining its proper quality The proposed method is normothermic ex-vivo liver perfusion (NEVLP), based on maintaining normal metabolic activity, which gives the opportunity to better assessment of liver viability before implantation. One of the possibilities is to assess the production of bile by the liver perfused in these conditions. It is considered that the production of bile alone is not sufficient evidence for the proper functioning of the liver and directs the research to assess the composition of bile. Therefore, it is assumed that changes in the concentration of bile acids, which are the main component of bile, may correlate with changes occurring in the transplanted organ.

Methods: The study was performed on bile samples obtained from two types of porcine model donors: heart beating donor (HBD) and donor after cardiac death (DCD). Samples were collected during SCS and NEVLP at specific time points: before organ harvest, during perfusion (for NEVLP), reperfusion and the first few days after transplantation. The DCD group was divided due to the time of organ ischemia: 30’ for SCS and 30’, 60’, 90’ for NEVLP (n=3 in each group). Sample preparation was performed according to the thin-film solid phase microextraction (TF-SPME), using C18 sorbent as the extraction phase. Extracts were analyzed using the LC-MS platform with Nexera UHPLC system and a triple quadrupole mass spectrometer LC–MS 8060 (Shimadzu) equipped with an ESI source in the negative-ion mode working in the multiple reaction monitoring (MRM) mode.

Results: The conjugated forms of bile acids (with taurine or glycine) were significantly predominant in the bile samples compared to unconjugated forms. Changes in concentrations of individual bile acids depending on the method of preservation and the period of organ ischemia were observed. The high concentration of taurocholic acid is characteristic for the perfusion period (eg. 3793,64±255,5 vs. 1,81±0,45 ug/mL compared to SHAM for 30'DCD) and is still present in the reperfusion of the 90’DCD group. Furthermore, prolonged ischemia caused an increase in taurodeoxycholic (15.87±8.22 vs. 2.83±0.57 ug/mL) and glycodeoxycholic acid (135.82±78.5 vs. 18.56±4.57 ug/mL) levels in the first days after transplantation compared to HBD group.

Conclusions: TF-SPME is a high-throughput sample preparation method that can be effectively used for profiling bile samples. Changes in bile acid concentrations in bile samples may correlate with the metabolic processes occurring in the transplanted organ. Further research into the composition of bile may allow to find biomarkers of liver function.