Abstract
Objectives
Bile acids serve as biomarkers for liver function and are indicators for cholestatic and hepatobiliary diseases like hepatitis, cirrhosis, and intrahepatic cholestasis of pregnancy (ICP). Sulfation and renal excretion of bile acids are important elimination steps. The power of ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) allows specific profiling of primary and secondary bile acids as well as their sulfated counterparts.
Methods
Twenty-four sulfated and non-sulfated primary and secondary bile acids were quantified in urine with 15 corresponding stable isotope labeled internal standards by using two-dimensional UHPLC-MS/MS. The sample preparation was based on a simple dilution with a methanolic zinc sulfate solution followed by an automated online solid phase extraction clean up.
Results
The validation results of the method fulfilled the criteria of the European Medicine Agency (EMA) “Guideline on bioanalytical method validation”. To verify fitness for purpose, 40 urine samples were analyzed which showed an average of 86% sulfation, 9.1% taurine-conjugation, 14% non-conjugation, and 77% glycine-conjugation rates.
Conclusions
Lossless one-pot sample preparation, automated sample purification, and high number of internal standards are major innovations of the presented profiling method, which may allow diagnostic application of BA profiling in the future.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
References
1. Alnouti, Y. Bile acid sulfation: a pathway of bile acid elimination and detoxification. Toxicol Sci 2009;108:225–46. https://doi.org/10.1093/toxsci/kfn268.Search in Google Scholar
2. Griffiths, WJ, Sjövall, J. Bile acids: analysis in biological fluids and tissues. J Lipid Res 2010;51:23–41. https://doi.org/10.1194/jlr.r001941-jlr200.Search in Google Scholar
3. Gressner, AM, Gressner, OA. Gallensäuren. In: Gressner, AM, Arndt, T, editors. Lexikon der Medizinischen Laboratoriumsdiagnostik. Berlin, Heidelberg: Springer Berlin Heidelberg; 2017.10.1007/978-3-662-49054-9Search in Google Scholar
4. Rassow, J. Biochemie: 50 Tabellen. 2., aktualisierte Aufl. Stuttgart: Thieme; 2008 (Duale Reihe).10.1055/b-002-85529Search in Google Scholar
5. Chiang, JY. Regulation of bile acid synthesis. Front Biosci 1998;3:176–93. https://doi.org/10.2741/a273.Search in Google Scholar
6. Wess, G, Enhsen, A, Kramer, W. Gallensäuren: Wiederentdeckt. Nachr. Chem. Tech. Lab. 1995;43:1047–55. https://doi.org/10.1002/nadc.19950431008.Search in Google Scholar
7. Mayo Clinic Laboratories. Test definition: BAFS: bile acids, fractioned and Tot, S; 2021. Available from: https://www.mayocliniclabs.com/test-catalog/download-setup.php?format=pdf&unit_code=62234.Search in Google Scholar
8. Shima, T, Tada, H, Morimoto, M, Nakagawa, Y, Obata, H, Sasaki, T, et al.. Serum total bile acid level as a sensitive indicator of hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment. J Gastroenterol Hepatol 2000;15:294–9. https://doi.org/10.1046/j.1440-1746.2000.02126.x.Search in Google Scholar
9. Sawkat Anwer, M, Meyer, DJ. Bile acids in the diagnosis, pathology, and therapy of hepatobiliary disease. Vet Clin North Am Small Anim Pract 1995;25:503–17. https://doi.org/10.1016/s0195-5616(95)50039-7.Search in Google Scholar
10. Huang, WM, Tropper, P, Seubert, D, Donnelly, J, Liu, M, Javitt, N. Random urinary bile acids as a diagnostic method for intrahepatic cholestasis of pregnancy (ICP). Am J Obstet Gynecol 2006;195:S121. https://doi.org/10.1016/j.ajog.2006.10.417.Search in Google Scholar
11. Marschall, H-U. Management of intrahepatic cholestasis of pregnancy. Expet Rev Gastroenterol Hepatol 2015;9:1273–9. https://doi.org/10.1586/17474124.2015.1083857.Search in Google Scholar PubMed
12. Tribe, RM, Dann, AT, Kenyon, AP, Seed, P, Shennan, AH, Mallet, A. Longitudinal profiles of 15 serum bile acids in patients with intrahepatic cholestasis of pregnancy. Am J Gastroenterol 2010;105:585–95. https://doi.org/10.1038/ajg.2009.633.Search in Google Scholar
13. Danese, E, Salvagno, GL, Negrini, D, Brocco, G, Montagnana, M, Lippi, G. Analytical evaluation of three enzymatic assays for measuring total bile acids in plasma using a fully-automated clinical chemistry platform. PLoS ONE 2017;12:e0179200. https://doi.org/10.1371/journal.pone.0179200.Search in Google Scholar
14. Liu, Y, Rong, Z, Xiang, D, Zhang, C, Liu, D. Detection technologies and metabolic profiling of bile acids: a comprehensive review. Lipids Health Dis 2018;17:121. https://doi.org/10.1186/s12944-018-0774-9.Search in Google Scholar
15. Almé, B, Bremmelgaard, A, Sjövall, J, Thomassen, P. Analysis of metabolic profiles of bile acids in urine using a lipophilic anion exchanger and computerized gas-liquid chromatography-mass spectrometry. J Lipid Res 1977;18:339–62. https://doi.org/10.1016/s0022-2275(20)41684-0.Search in Google Scholar
16. Alnouti, Y, Csanaky, IL, Klaassen, CD. Quantitative-profiling of bile acids and their conjugates in mouse liver, bile, plasma, and urine using LC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2008;873:209–17. https://doi.org/10.1016/j.jchromb.2008.08.018.Search in Google Scholar
17. Batta, A, Kumar, SG. Gas chromatography of bile acids. J Chromatogr B 1999;723:1–16. https://doi.org/10.1016/s0378-4347(98)00528-3.Search in Google Scholar
18. Amplatz, B, Zöhrer, E, Haas, C, Schäffer, M, Stojakovic, T, Jahnel, J, et al.. Bile acid preparation and comprehensive analysis by high performance liquid chromatography-high-resolution mass spectrometry. Clin Chim Acta 2017;464:85–92. https://doi.org/10.1016/j.cca.2016.11.014.Search in Google Scholar PubMed
19. Luo, L, Aubrecht, J, Li, D, Warner, RL, Johnson, KJ, Kenny, J, et al.. Assessment of serum bile acid profiles as biomarkers of liver injury and liver disease in humans. PLoS ONE 2018;13:1–17. https://doi.org/10.1371/journal.pone.0193824.Search in Google Scholar PubMed PubMed Central
20. Sarafian, MH, Lewis, MR, Pechlivanis, A, Ralphs, S, McPhail, MJW, Patel, VC, et al.. Bile acid profiling and quantification in biofluids using ultra-performance liquid chromatography tandem mass spectrometry. Anal Chem 2015;87:9662–70. https://doi.org/10.1021/acs.analchem.5b01556.Search in Google Scholar PubMed
21. Scherer, M, Gnewuch, C, Schmitz, G, Liebisch, G. Rapid quantification of bile acids and their conjugates in serum by liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2009;877:3920–5. https://doi.org/10.1016/j.jchromb.2009.09.038.Search in Google Scholar PubMed
22. Burkard, I, Eckardstein, Avon, Rentsch, KM. Differentiated quantification of human bile acids in serum by high-performance liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2005;826:147–59. https://doi.org/10.1016/j.jchromb.2005.08.016.Search in Google Scholar
23. Huang, J, Bathena, SPR, Csanaky, IL, Alnouti, Y. Simultaneous characterization of bile acids and their sulfate metabolites in mouse liver, plasma, bile, and urine using LC-MS/MS. J Pharm Biomed 2011;55:1111–9. https://doi.org/10.1016/j.jpba.2011.03.035.Search in Google Scholar
24. Ducroq, DH, Morton, MS, Shadi, N, Fraser, HL, Strevens, C, Morris, J, et al.. Analysis of serum bile acids by isotope dilution-mass spectrometry to assess the performance of routine total bile acid methods. Ann Clin Biochem 2010;47:535–40. https://doi.org/10.1258/acb.2010.010154.Search in Google Scholar
25. Sangaraju, D, Shi, Y, van Parys, M, Ray, A, Walker, A, Caminiti, R, et al.. Robust and comprehensive targeted metabolomics method for quantification of 50 different primary, secondary, and sulfated bile acids in multiple biological species (human, monkey, rabbit, dog, and rat) and matrices (plasma and urine) using liquid chromatography high resolution mass spectrometry (LC-HRMS) analysis. J Am Soc Mass Spectrom 2021;32:2033–49. https://doi.org/10.1021/jasms.0c00435.Search in Google Scholar
26. Wielders, JPM, Mink, JK. Analysis of vanillylmandelic acid, homovanillic acid and 5-hydroxyindoleacetic acid in human urine by high-performance liquid chromatography and fluorometry. J Chromatogr 1984;310:379–85. https://doi.org/10.1016/0378-4347(84)80103-6.Search in Google Scholar
27. European Medicines Agency. Guideline bioanalytical method validation. London, UK: European Medicines Agency; 2011. Available from: http://www.ema.europa.eu/docs/en GB/document library/Scientific guideline/2011/08/WC500109686.pdf.Search in Google Scholar
28. Bonfiglio, R, King, RC, Olah, TV, Merkle, K. The effects of sample preparation methods on the variability of the electrospray ionization response for model drug compounds. Rapid Commun Mass Spectrom 1999;13:1175–85. https://doi.org/10.1002/(sici)1097-0231(19990630)13:12<1175::aid-rcm639>3.0.co;2-0.10.1002/(SICI)1097-0231(19990630)13:12<1175::AID-RCM639>3.0.CO;2-0Search in Google Scholar
29. Belyakova, LA, Besarab, LN, Roik, NV, Lyashenko, DY, Vlasova, NN, Golovkova, LP, et al.. Designing of the centers for adsorption of bile acids on a silica surface. J Colloid Interface Sci 2006;294:11–20. https://doi.org/10.1016/j.jcis.2005.06.081.Search in Google Scholar
30. Belyakova, LA, Vlasova, NN, Golovkova, LP, Varvarin, AM, Lyashenko, DY, Svezhentsova, AA, et al.. Role of surface nature of functional silicas in adsorption of monocarboxylic and bile acids. J Colloid Interface Sci 2003;258:1–9. https://doi.org/10.1016/s0021-9797(02)00093-0.Search in Google Scholar
31. Tagliacozzi, D. Quantitative analysis of bile acids in human plasma by liquid chromatography-electrospray. Clin Chem Lab Med 2003;41:1633–41. https://doi.org/10.1515/CCLM.2003.247.Search in Google Scholar
32. Bathena, SPR, Mukherjee, S, Olivera, M, Alnouti, Y. The profile of bile acids and their sulfate metabolites in human urine and serum. J Chromatogr B Analyt Technol Biomed Life Sci 2013;942-943:53–62. https://doi.org/10.1016/j.jchromb.2013.10.019.Search in Google Scholar
33. Perwaiz, S, Tuchweber, B, Mignault, D, Gilat, T, Yousef, IM. Determination of bile acids in biological fluids by liquid chromatography-electrospray tandem mass spectrometry. J Lipid Res 2001;42:114–9. https://doi.org/10.1016/s0022-2275(20)32342-7.Search in Google Scholar
34. Simko, V, Michael, S, Kelley, RE. Predictive value of random sample urine bile acids corrected by creatinine in liver disease. Hepatology 1987;7:115–21. https://doi.org/10.1002/hep.1840070123.Search in Google Scholar PubMed
35. Bathena, SPR, Thakare, R, Gautam, N, Mukherjee, S, Olivera, M, Meza, J, et al.. Urinary bile acids as biomarkers for liver diseases I. Stability of the baseline profile in healthy subjects. Toxicol Sci 2015;143:296–307. https://doi.org/10.1093/toxsci/kfu227.Search in Google Scholar PubMed
36. Jahnel, J, Zöhrer, E, Scharnagl, H, Erwa, W, Fauler, G, Stojakovic, T. Reference ranges of serum bile acids in children and adolescents. Clin Chem Lab Med 2015;53:1807–13. https://doi.org/10.1515/cclm-2014-1273.Search in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2021-1111).
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