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Varga GM, Spendal M, Sigh J, Søeborg T, Nielsen NJ. Interference from anti-drug antibodies on the quantification of insulin: a comparison of an LC-MS/MS assay and immunoassays. Bioanalysis 2024:1-11. [PMID: 39262387 DOI: 10.1080/17576180.2024.2389637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/05/2024] [Indexed: 09/13/2024] Open
Abstract
Aim: This study aims to compare the anti-drug antibody (ADA) interference in four pharmacokinetic (PK) assays across different platforms (AlphaLISA, Gyrolab, LC-MS/MS) and to devise a strategy for ADA interference mitigation to improve the accuracy of measured drug in total PK assays.Materials & methods: Spiked test samples, created to achieve different ADA concentrations in human serum also containing an insulin analogue, were analyzed alongside pooled clinical samples using four assays.Results & conclusion: Interference was observed in all platforms. A novel approach using the Gyrolab mixing CD, including acid dissociation in the PK assay, significantly reduced interference and thereby improved relative error from >99% to ≤20% yielding measurements well within the acceptance criteria. Clinical sample results reinforced findings from the test samples.
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Affiliation(s)
- Georgina Marta Varga
- Analytical Chemistry Group, Department of Plant & Environmental Science, Faculty of Science, University of Copenhagen, Frederiksberg C, DK-1871, Denmark
- Non-clinical & Clinical Assay Sciences, Global Discovery & Development Sciences, Novo Nordisk A/S Måløv, DK-2760, Denmark
| | - Manca Spendal
- Analytical Chemistry Group, Department of Plant & Environmental Science, Faculty of Science, University of Copenhagen, Frederiksberg C, DK-1871, Denmark
- Non-clinical & Clinical Assay Sciences, Global Discovery & Development Sciences, Novo Nordisk A/S Måløv, DK-2760, Denmark
| | - Jens Sigh
- Non-clinical & Clinical Assay Sciences, Global Discovery & Development Sciences, Novo Nordisk A/S Måløv, DK-2760, Denmark
| | - Tue Søeborg
- Non-clinical & Clinical Assay Sciences, Global Discovery & Development Sciences, Novo Nordisk A/S Måløv, DK-2760, Denmark
| | - Nikoline Juul Nielsen
- Analytical Chemistry Group, Department of Plant & Environmental Science, Faculty of Science, University of Copenhagen, Frederiksberg C, DK-1871, Denmark
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Thomas A, Krombholz S, Breuer J, Walpurgis K, Thevis M. Insulin-mimetic peptides in sports drug testing. Drug Test Anal 2023; 15:1468-1476. [PMID: 37691519 DOI: 10.1002/dta.3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
Because of its influence on carbohydrate metabolism and, at the same time, anti-catabolic effects, the misuse of the peptide hormone insulin and its synthetic analogs is prohibited in sports at all times according to the regulations of the World Anti-Doping Agency (WADA). The biological effects of insulin and its analogs are mediated through binding to the insulin receptor, which was also found to be activated by different peptides structurally largely unrelated to insulin. Such insulin-mimetic peptides or selective-insulin receptor modulators (SIRMs) represent a novel class of potential performance-enhancing agents, which is currently not explicitly mentioned on the WADA Prohibited List. Within this research project, advanced solid-phase extraction (SPE) and liquid chromatography coupled to high-resolution tandem mass spectrometry (LC-HRMS/MS) were employed to develop a fast, reliable, and specific assay for the detection of the insulin-mimetic peptides S597 and S519 from plasma. Method validation demonstrated a detection limit of 0.5 ng/mL and successfully illustrated the applicability of the approach to routine sports drug testing programs. Moreover, sophisticated and comprehensive in vitro metabolism experiments were conducted, and several metabolic degradation products were identified, which will enhance the information generated from future analyses of doping control samples.
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Affiliation(s)
- Andreas Thomas
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Sophia Krombholz
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Johanna Breuer
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Katja Walpurgis
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Cologne, Germany
- European Monitoring Center for Emerging Doping Agents (EuMoCEDA), Cologne/Bonn, Germany
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3
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Vollmer AC, Wagmann L, Weber AA, Meyer MR. Simultaneous analysis of antihyperglycemic small molecule drugs and peptide drugs by means of dual liquid chromatography high-resolution mass spectrometry. Clin Chem Lab Med 2023; 61:1300-1308. [PMID: 37011023 DOI: 10.1515/cclm-2022-1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES The study aimed to evaluate dual liquid chromatography (LC) coupled to high-resolution mass spectrometry (HRMS) for the simultaneous analysis of small and large molecule drugs by development and application of a validated bioanalytical method. METHODS The oral antihyperglycemic drugs (OAD) dapagliflozin, empagliflozin, glibenclamide, glimepiride, metformin, pioglitazone, repaglinide, saxagliptin, sitagliptin, and vildagliptin, as well as the antihyperglycemic peptides exenatide, human insulin, insulin aspart, insulin degludec, insulin detemir, insulin glargine, insulin glulisine, insulin lispro, and semaglutide were included in the analytical procedure. Analytes were extracted using a combination of protein precipitation and solid-phase extraction. Two identical reversed-phase columns were used for separation followed by Orbitrap high-resolution mass spectrometry. The whole procedure was validated according to international recommendations. RESULTS Different MS parameters had to be used for the two analyte groups, but dual LC separation allowed elution of all analytes within 12 min using the same column type. The analytical procedure was accurate and precise for most of the compounds except for exenatide, semaglutide, and insulin glargine, which were included qualitatively in the method. Analysis of proof-of-concept samples revealed OAD concentrations mostly within their therapeutic range, insulins could be detected in five cases but at concentrations below the lower limit of quantification except for one case. CONCLUSIONS Dual LC in combination with HRMS was shown to be a suitable platform to analyze small and large molecules in parallel and the current method allowed the determination of a total of 19 antihyperglycemic drugs in blood plasma within 12 min.
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Affiliation(s)
- Aline C Vollmer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
| | - Lea Wagmann
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
| | - Armin A Weber
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
| | - Markus R Meyer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Center for Molecular Signaling (PZMS), Saarland University, Homburg, Germany
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4
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Insulin murder and the case of Colin Norris. J Forensic Leg Med 2023; 94:102483. [PMID: 36680946 DOI: 10.1016/j.jflm.2023.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
Although insulin is an essential medicine and a life-saving drug, it has also been incriminated in many poisoning deaths; accidental, suicidal and some with malicious intent. Overdosing with insulin precipitates a life-threatening state of hypoglycemia and if untreated leads to coma, irreversible brain damage and death. Normally, the pancreatic β-cells secrete equimolar amounts of insulin and C-peptide into the portal venous blood, although under physiological conditions the plasma concentration ratio (insulin/C-peptide) is less than unity, because insulin is more susceptible to hepatic first-pass metabolism. A high ratio of insulin/C-peptide in plasma from a poisoned patient is compelling evidence that pharmaceutical insulin was administered, which does not contain C-peptide. The analysis of insulin and C-peptide was traditionally done by immunoassay methods (RIA and/or ELISA), although high resolution LC-MS/MS is more suitable for forensic purposes and permits the identification of insulin analogues. Use of insulin as a murder weapon is exemplified by the case of Colin Norris, a male nurse found guilty of murdering four elderly patients and the attempted murder of a fifth by injecting them with insulin. However, the prosecution evidence against Norris was mainly circumstantial and hearsay. Toxicological evidence against Norris consisted of a high insulin/C-peptide concentration ratio in plasma from one of the victims. This analysis was done by an immunoassay method at a clinical laboratory and not a forensic laboratory. Analytical procedures, including chain-of-custody routines, are more stringent at forensic laboratories. Since his conviction, some of the medical evidence against Norris has been called into question, especially the prevalence of spontaneous attacks of hypoglycemia in elderly and frail patients with co-morbidities.
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Zhang S, Wang XC, Li J, Wang XH, Wang Y, Zhang YJ, Du MY, Zhang MY, Lin JN, Li CJ. Establishment and Validation of a New Predictive Model for Insulin Resistance based on 2 Chinese Cohorts: A Cross-Sectional Study. Int J Endocrinol 2022; 2022:8968793. [PMID: 36299856 PMCID: PMC9592226 DOI: 10.1155/2022/8968793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Visceral adiposity plays a key role in the development of insulin resistance (IR), so surrogate index that can indicate visceral obesity may have higher predictive value for IR. This study aimed to establish and validate a new predictive model including indicator of visceral obesity for IR. Methods The study population consisted of two cohorts. The derivation cohort was a group of 667 patients with newly diagnosed type 2 diabetes and the population undergoing a routine health checkup was the validation cohort. The predictive model was established by the logistic regression analysis. Its value for predicting IR was compared with other surrogate indices by the receiver operating characteristic curve. Results The odds ratio (OR) of age, visceral fat area (VFA), triglyceride (TG), fasting plasma glucose (FPG), and alanine aminotransferase (ALT) for IR was 1.028 (95% CI, 1.008-1.048) (P < 0.01), 1.016 (95% CI, 1.009-1.023) (P < 0.001), 1.184 (95% CI, 1.005-1.396) (P < 0.05), 1.334 (95% CI, 1.225-1.451) (P < 0.001), and 1.021 (95% CI, 1.001-1.040) (P < 0.05). The formula of the predictive model was (0.0293 × age + 1.4892 × Ln VFA + 0.4966 × Ln TG + 2.784 × Ln FPG + 0.6906 × Ln ALT)/2. The area under the curve was the largest among all the previously reported predictors. Conclusions This study established and validated a predicting model for IR and confirmed its predictive value in comparison with other surrogate indicators, which will offer a simple and effective tool to measure IR in future large population studies.
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Affiliation(s)
- Shi Zhang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Xin-Cheng Wang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Jing Li
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Xiao-He Wang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yi Wang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Yan-Ju Zhang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Mei-Yang Du
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | | | - Jing-Na Lin
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Chun-Jun Li
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
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Hamidli N, Pajaziti B, Andrási M, Nagy C, Gáspár A. Determination of human insulin and its six therapeutic analogues by capillary electrophoresis - mass spectrometry. J Chromatogr A 2022; 1678:463351. [PMID: 35905683 DOI: 10.1016/j.chroma.2022.463351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 11/18/2022]
Abstract
In this work, human insulin and its 6 analogues were separated and determined using CZE-MS. Three different capillaries (bare fused silica, successive multiple ionic-polymer layer (SMIL) and static linear polyacrylamide (LPA) coated) were compared based on their separation performances in their optimal operating conditions. Coated capillaries demonstrated slightly better separation of the components, although some components showed wide, distorted peaks. The highest plate number could be obtained in the SMIL capillary (192 000/m). For UV and ESI-MS detection relatively similar LOD values were obtained (0.3-1.2 mg/L and 1.0-3.4 mg/L, respectively). The application of MS detection provided useful structural information and unambiguous identification for insulins having similar or the same molecular mass. This work is considered to be important not only for the investigation of insulins but also for its potential contribution to the top-down analysis of proteins using CE-MS.
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Affiliation(s)
- Narmin Hamidli
- Department of Inorganic and Analytical Chemistry, University of Debrecen, Egyetem tér 1, Debrecen H-4032, Hungary
| | - Blerta Pajaziti
- Department of Inorganic and Analytical Chemistry, University of Debrecen, Egyetem tér 1, Debrecen H-4032, Hungary
| | - Melinda Andrási
- Department of Inorganic and Analytical Chemistry, University of Debrecen, Egyetem tér 1, Debrecen H-4032, Hungary
| | - Cynthia Nagy
- Department of Inorganic and Analytical Chemistry, University of Debrecen, Egyetem tér 1, Debrecen H-4032, Hungary
| | - Attila Gáspár
- Department of Inorganic and Analytical Chemistry, University of Debrecen, Egyetem tér 1, Debrecen H-4032, Hungary.
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7
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Interest of HRMS systems in analytical toxicology: Focus on doping products. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Zhang S, Huang YP, Li J, Wang WH, Zhang MY, Wang XC, Lin JN, Li CJ. The Visceral-Fat-Area-to-Hip-Circumference Ratio as a Predictor for Insulin Resistance in a Chinese Population with Type 2 Diabetes. Obes Facts 2022; 15:621-628. [PMID: 35724630 PMCID: PMC9421683 DOI: 10.1159/000525545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Adipose tissue deposited on the viscera is the main culprit in the development of insulin resistance (IR) and cardiometabolic diseases, whereas subcutaneous adipose tissue may have a protective role. This study aimed to propose a new predictive index - the visceral-fat area (VFA)-to-hip-circumference ratio (VHR) and explore its efficacy for prediction of IR in a Chinese population with type 2 diabetes mellitus. METHODS A total of 643 patients with newly diagnosed diabetes were enrolled in this study. Body composition, anthropometrical, and biochemical measurements were performed. IR was defined as homeostatic model assessment of IR (HOMA-IR) > 2.69. The association between VHR and IR was analyzed. RESULTS Regardless of gender, subjects in the IR group had higher VHR, body mass index (BMI), VFA, body fat percentage, systolic blood pressure, diastolic blood pressure (DBP), fasting blood glucose, fasting insulin, triglyceride (TG), uric acid (UA), homocysteine, and aminotransferases than those in the non-IR group. The other concomitant metabolic disorders were more common in the IR group. Further analysis showed that with the increase of VHR, the levels of HOMA-IR, BMI, VFA, DBP, TG, UA and the prevalence of nonalcoholic fatty-liver disease, hypertension, and hyperuricemia increased continuously (p trend <0.01). The linear trend test showed that VHR and IR remained closely correlated after adjusting for possible confounders (p trend <0.05). The receiver operating characteristic curve analysis showed that the area under the curve was 0.69, and the optimal cutoff of VHR was 0.89 (sensitivity 79.3%, specificity 61.5%). CONCLUSION VHR was positively associated with IR regardless of gender, and it might be a reliable predictor for IR.
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Affiliation(s)
- Shi Zhang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China,
| | - Ya-Ping Huang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Jing Li
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Wen-Hong Wang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | | | - Xin-Cheng Wang
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Jing-Na Lin
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
| | - Chun-Jun Li
- Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, China
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Thomas A, Benzenberg L, Bally L, Thevis M. Facilitated Qualitative Determination of Insulin, Its Synthetic Analogs, and C-Peptide in Human Urine by Means of LC-HRMS. Metabolites 2021; 11:309. [PMID: 34065812 PMCID: PMC8151387 DOI: 10.3390/metabo11050309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/31/2022] Open
Abstract
The increasing importance to determine bioactive peptide hormones such as insulin, its synthetic analogs, and C-peptide in urine samples represents an analytical challenge. The physiological concentrations of insulin in urine are commonly found at sub-ng/mL levels and thus represent a complex analytical task. C-peptide concentrations, on the other hand, tend to be in the moderate ng/mL range and are hence much easier to determine. Insulin and C-peptide are important in the diagnostics and management of metabolic disorders such as diabetes mellitus and are also particularly relevant target analytes in professional sports and forensics. All insulins are classified on the World Anti-Doping Agency's (WADA) list of prohibited substances and methods in sports with a minimum required performance level (MRPL) of 50 pg/mL. Until now, methods combining immunoextraction and subsequent mass spectrometric detection have mostly been used for this purpose. With the method developed here, sample preparation has been simplified considerably and does not require an antibody-based sample purification. This was achieved by a sophisticated mixed-mode solid-phase extraction and subsequent separation with liquid chromatography coupled to high-resolution mass spectrometry. Included target insulins were human, lispro, glulisine, aspart, glargine metabolite, degludec, and additionally, human C-peptide. The method was validated for the synthetic insulin analogs considering WADA requirements including specificity, limit of detection (10-25 pg/mL), limit of identification, recovery (25-100%), robustness, carry over (<2%), and matrix effects. All sample preparation steps were controlled by two stable isotope-labeled internal standards, namely, [[2H10] LeuB6, B11, B15, B17]-insulin and [[13C6] Leu26, 30] C-peptide. Finally, the method was applied to samples from patients with diabetes mellitus treated with synthetic insulins.
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Affiliation(s)
- Andreas Thomas
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; (L.B.); (M.T.)
| | - Lukas Benzenberg
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; (L.B.); (M.T.)
| | - Lia Bally
- Department of Diabetes: Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany; (L.B.); (M.T.)
- European Monitoring Center for Emerging Doping Agents (EuMoCEDA), 50933 Cologne/Bonn, Germany
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Bottinelli C, Bévalot F, Cartiser N, Fanton L, Guitton J. Detection of insulins in postmortem tissues: an optimized workflow based on immunopurification and LC-MS/HRMS detection. Int J Legal Med 2021; 135:1813-1822. [PMID: 33932171 DOI: 10.1007/s00414-021-02598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
Diabetes is a worldwide disease in perpetual expansion. Type 1 and sometimes type 2 diabetic patients require daily human insulin (HI) or analog administration. Easy access to insulins for insulin-treated diabetics, their relatives, and medical professionals can enable abuse for suicidal or homicidal purpose. However, demonstrating insulin overdose in postmortem blood is challenging. Tissue analyses are contributive, as insulins can accumulate before death or undergo only limited degradation. The present study describes an assay for HI and synthetic analogs (lispro, aspart, glulisine, detemir and degludec, glargine and its main metabolite (M1)) in liver, kidney, muscle, and injection site samples. It is based on a 5-step sample preparation (reduction of tissue sample size, homogenization, extraction, concentration, and immunopurification) associated with liquid chromatography coupled to high-resolution mass spectrometry (LC-MS/HRMS). Selectivity and limit of detection (LOD) for all target analogs were assessed in the above matrices. LOD was determined at 25 ng/g for HI and for analogs except detemir and degludec, where LOD was 50 ng/g in kidney and injection site samples and 80 ng/g in the liver and muscle. The method was applied to13 forensic cases in which insulin use was suspected.
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Affiliation(s)
- Charline Bottinelli
- LAT LUMTOX Laboratory, 32 Rue du 35ème Régiment d'Aviation 69500, Bron, France.
| | - Fabien Bévalot
- LAT LUMTOX Laboratory, 32 Rue du 35ème Régiment d'Aviation 69500, Bron, France
| | - Nathalie Cartiser
- Department of Forensic Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laurent Fanton
- Department of Forensic Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,Faculty of Medicine Lyon-Est, University of Lyon, UCBL1, Lyon, France
| | - Jérôme Guitton
- Toxicology Laboratory, ISPB Faculty of Pharmacy, University of Lyon, UCBL1, Lyon, France.,Pharmacology-Toxicology Laboratory, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
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11
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Judák P, Esposito S, Coppieters G, Van Eenoo P, Deventer K. Doping control analysis of small peptides: A decade of progress. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1173:122551. [PMID: 33848801 DOI: 10.1016/j.jchromb.2021.122551] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 02/06/2023]
Abstract
Small peptides are handled in the field of sports drug testing analysis as a separate group doping substances. It is a diverse group, which includes but is not limited to growth hormone releasing-factors and gonadotropin-releasing hormone analogues. Significant progress has been achieved during the past decade in the doping control analysis of these peptides. In this article, achievements in the application of liquid chromatography-mass spectrometry-based methodologies are reviewed. To meet the augmenting demands for analyzing an increasing number of samples for the presence of an increasing number of prohibited small peptides, testing methods have been drastically simplified, whilst their performance level remained constant. High-resolution mass spectrometers have been installed in routine laboratories and became the preferred detection technique. The discovery and implementation of metabolites/catabolites in testing methods led to extended detection windows of some peptides, thus, contributed to more efficient testing in the anti-doping community.
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Affiliation(s)
- Péter Judák
- Department of Diagnostic Sciences, Doping Control Laboratory, Ghent University, Zwijnaarde, Belgium.
| | - Simone Esposito
- ADME/DMPK Department, Drug Discovery Division, IRBM S.p.A, Pomezia, Rome, Italy
| | - Gilles Coppieters
- Department of Diagnostic Sciences, Doping Control Laboratory, Ghent University, Zwijnaarde, Belgium
| | - Peter Van Eenoo
- Department of Diagnostic Sciences, Doping Control Laboratory, Ghent University, Zwijnaarde, Belgium
| | - Koen Deventer
- Department of Diagnostic Sciences, Doping Control Laboratory, Ghent University, Zwijnaarde, Belgium
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Bottinelli C, Nicoli R, Bévalot F, Cartiser N, Roger C, Chikh K, Kuuranne T, Fanton L, Guitton J. Development and validation of a method for quantification of human insulin and its synthetic analogues in plasma and post-mortem sera by LC-MS/HRMS. Talanta 2020; 225:122047. [PMID: 33592769 DOI: 10.1016/j.talanta.2020.122047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022]
Abstract
Analysis of human insulin and its synthetic analogues is increasingly requested for clinical monitoring, for anti-doping purposes, but also for forensic cases. Indeed, insulin analogues may be abused for suicide or homicide - whence their forensic interest. Collection and storage conditions, as well as the phenomenon of degradation make post-mortem serum samples analytically challenging and consequently, the rate of exogenous insulin administration as cause of death is undoubtedly underestimated. However, with recent technological advances and the development of new extraction techniques particularly for anti-doping analyses, detection of insulins in post-mortem samples seems to be achievable. This study describes the first validated quantitative method for analysis human insulin and its six analogues (lispro, aspart, glulisine, glargine, detemir and degludec) in plasma and post-mortem sera. Various extraction processes, namely precipitation + solid phase extraction (SPE), filtration + SPE, precipitation + SPE + immunopurification, and filtration + immunopurification, were assessed to evaluate the lowest limit of detection for all target analogues. The selected sample preparation consists of filtration step followed by immunopurification extraction with an anti-body precoated ELISA plate for plasma. For post-mortem sera, the first step of precipitation was added to remove matrix interferences. The extracts were analyzed by ultra-high-performance liquid chromatography-high resolution mass spectrometry (LC-HRMS), interfaced by electrospray (ESI). The method was validated with respect linearity, precision, accuracy, recovery, matrix effect, dilution and carryover. The limit of quantification (LOQ) in plasma was 0.5 ng/mL for human insulin and rapid-acting insulins, 1.0 ng/mL for glargine, 2.5 ng/mL for degludec and 10 ng/mL for detemir. Two types of post-mortem sera were studied based on the post-mortem interval (PMI): inferior or superior to 48 h. The obtained LOQ were the same for each analogue, independent from the PMI: 1.0 ng/mL for human insulin and rapid-acting insulins, 1.0 ng/mL for glargine, 2.5 ng/mL for degludec and 10 ng/mL for detemir. At the LOQ level, for all insulins and all samples, accuracy was between 70 and 130% and precision inferior to 30%. The validated method was applied to five subjects participating in therapeutic monitoring of insulin and to seven post-mortem cases.
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Affiliation(s)
- C Bottinelli
- LAT LUMTOX Laboratory, 32 Rue Du 35(ème) Régiment D'Aviation, 69500, Bron, France.
| | - R Nicoli
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Switzerland
| | - F Bévalot
- LAT LUMTOX Laboratory, 32 Rue Du 35(ème) Régiment D'Aviation, 69500, Bron, France
| | - N Cartiser
- Hospices Civils de Lyon, Edouard Herriot Hospital, Service of Forensic Medicine, France
| | - C Roger
- Biochemistry Laboratory, Lyon-Sud Hospital, Hospices Civils de Lyon, France
| | - K Chikh
- Biochemistry Laboratory, Lyon-Sud Hospital, Hospices Civils de Lyon, France
| | - T Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Lausanne and Geneva, Lausanne University Hospital and University of Lausanne, Switzerland
| | - L Fanton
- Hospices Civils de Lyon, Edouard Herriot Hospital, Service of Forensic Medicine, France; University of Lyon, UCBL1, Faculty of Medicine Lyon-Est, France
| | - J Guitton
- Toxicology Laboratory, ISPB Faculty of Pharmacy, University of Lyon, UCBL1, France; Pharmacology-Toxicology Laboratory, Lyon-Sud Hospital, Hospices Civils de Lyon, France
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13
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Maurer HH. Hyphenated high-resolution mass spectrometry-the "all-in-one" device in analytical toxicology? Anal Bioanal Chem 2020; 413:2303-2309. [PMID: 33247339 PMCID: PMC7987635 DOI: 10.1007/s00216-020-03064-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
This trend article reviews papers with hyphenated high-resolution mass spectrometry (HRMS) approaches applied in analytical toxicology, particularly in clinical and forensic toxicology published since 2016 and referenced in PubMed. The article focuses on the question of whether HRMS has or will become the all-in-one device in these fields as supposed by the increasing number of HRMS presentations at scientific meetings, corresponding original papers, and review articles. Typical examples for the different application fields are discussed such as targeted or untargeted drug screening, quantification, drug metabolism studies, and metabolomics approaches. Considering the reviewed papers, HRMS is currently the only technique that fulfills the criteria of an all-in-one device for the various applications needed in analytical toxicology. Graphical abstract![]()
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Affiliation(s)
- Hans H Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, Saarland University, 66421, Homburg (Saar), Germany.
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14
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Reverter-Branchat G, Groessl M, Nakas CT, Prost JC, Antwi K, Niederkofler EE, Bally L. Rapid quantification of insulin degludec by immunopurification combined with liquid chromatography high-resolution mass spectrometry. Anal Bioanal Chem 2020; 412:8351-8359. [PMID: 33006670 PMCID: PMC7680744 DOI: 10.1007/s00216-020-02971-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022]
Abstract
Insulin degludec is an ultra-long-acting insulin analogue that is increasingly being used in diabetes due to its favourable efficacy and safety profile. Thus, there is an increasing demand for a reliable and specific analytical method to quantify insulin degludec for research, pharmaceutical industry and clinical applications. We developed and validated an automated, high-throughput method for quantification of insulin degludec in human blood samples across the expected clinical range combining immunopurification with high-resolution mass spectrometry. Validation was performed according to the requirements of the US Food and Drug Administration. The method satisfyingly met the following parameters: lower limit of quantification (120 pM), linearity, accuracy (error < 5%), precision (CV < 7.7%), selectivity, carry-over, recovery (89.7–97.2%), stability and performance in the presence of other insulin analogues. The method was successfully applied to clinical samples of patients treated with insulin degludec showing a good correlation with the administered dose (r2 = 0.78). High usability of the method is supported by the small specimen volume, automated sample processing and short analysis time. In conclusion, this reliable, easy-to-use and specific mass spectrometric insulin degludec assay offers great promise to address the current unmet need for standardized insulin analytics in academic and industrial research. Graphical Abstract ![]()
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Affiliation(s)
- Gemma Reverter-Branchat
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Michael Groessl
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3012, Bern, Switzerland.
| | - Christos T Nakas
- Laboratory of Biometry, School of Agriculture, University of Thessaly, 38446, Nea Ionia, Magnesia, Greece.,University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Jean-Christophe Prost
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Kwasi Antwi
- Thermo Fisher Scientific, Tempe, AZ, 85280, USA
| | | | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
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15
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Andrasi M, Pajaziti B, Sipos B, Nagy C, Hamidli N, Gaspar A. Determination of deamidated isoforms of human insulin using capillary electrophoresis. J Chromatogr A 2020; 1626:461344. [DOI: 10.1016/j.chroma.2020.461344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/27/2022]
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16
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Bottinelli C, Cartiser N, Bévalot F, Fanton L, Guitton J. Is insulin intoxication still the perfect crime? Analysis and interpretation of postmortem insulin: review and perspectives in forensic toxicology. Crit Rev Toxicol 2020; 50:324-347. [PMID: 32458714 DOI: 10.1080/10408444.2020.1762540] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Insulin is an anabolic hormone essential to glucose homeostasis. Insulin therapy, comprising human insulin (HI) or biosynthetic analogs, is critical for the management of type-1 diabetes and many of type-2 diabetes. However, medication error including non-adapted dose and confusion of insulin type, and misuse, such as massive self-administration or with criminal intent, can have lethal consequences. The aim of this paper is to review the state of knowledge of insulin analysis in biological samples and of the interpretation of insulin concentrations in the situation of insulin-related death investigations. Analytic aspects are considered, as quantification can be strongly impacted by methodology. Immunoanalysis, the historical technique, has a prominent role due to its sensitivity and ease of implementation. Recently, liquid chromatography coupled to mass spectrometry has provided indispensable selectivity in forensic contexts, distinguishing HI, analogs, and degradation products. We review the numerous antemortem (dose, associated pathology, injection-to-death interval, etc.) and postmortem parameters (in corpore degradation, in vitro degradation related to hemolysis, etc.) involved in the interpretation of insulin concentration. The interest and limitations of various alternative matrices providing a valuable complement to blood analysis are discussed. Vitreous humor is one of the most interesting, but the low diffusion of insulin in this matrix entails very low concentrations. Injection site analysis is relevant for identifying which type of insulin was administered. Muscle and renal cortex are matrices of particular interest, although additional studies are required. A table containing most case reports of fatal insulin poisoning published, with analytical data, completes this review. A logic diagram is proposed to highlight analytical issues and the main parameters to be considered for the interpretation of blood concentrations. Finally, it remains a challenge to provide reliable biological data and solid interpretation in the context of death related to insulin overdose. However, the progress of analytical tools is making the "perfect crime" ever more difficult to commit.
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Affiliation(s)
| | - Nathalie Cartiser
- Département de médecine légale, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Fanton
- Département de médecine légale, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France.,Faculté de médecine Lyon Est, Institut de Médecine Légale, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Guitton
- Laboratoire de Toxicologie, ISPB-Faculté de Pharmacie, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Hospices Civils de Lyon, Laboratoire de Pharmacologie-Toxicologie, Centre Hospitalier Lyon-Sud, Pierre Bénite Cedex, France
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17
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Holmes DT, Romney MG, Angel P, DeMarco ML. Proteomic applications in pathology and laboratory medicine: Present state and future prospects. Clin Biochem 2020; 82:12-20. [PMID: 32442429 DOI: 10.1016/j.clinbiochem.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022]
Abstract
Clinical mass spectrometry applications have traditionally focused on small molecules, particularly in the areas of therapeutic drug monitoring, toxicology, and measurement of endogenous and exogenous steroids. More recently, the use of matrix assisted laser desorption/ionization time of flight mass spectrometry for the identification of microbial pathogens has been widely implemented. Following this evolution, there has been an expanding role for the measurement of peptides and proteins in pathology and laboratory medicine. This review explores the current state of protein measurement by clinical mass spectrometry and the analytical strategies employed, as well as emerging applications in clinical chemistry, clinical microbiology and anatomical pathology.
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Affiliation(s)
- Daniel T Holmes
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada; University of British Columbia Department of Pathology and Laboratory Medicine, Vancouver, BC V6T 2B5 Canada.
| | - Marc G Romney
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada; University of British Columbia Department of Pathology and Laboratory Medicine, Vancouver, BC V6T 2B5 Canada.
| | - Peggi Angel
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charelston, SC 29425 Canada.
| | - Mari L DeMarco
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada; University of British Columbia Department of Pathology and Laboratory Medicine, Vancouver, BC V6T 2B5 Canada.
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18
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Thomas A, Yang R, Petring S, Bally L, Thevis M. Simplified quantification of insulin, its synthetic analogs and C‐peptide in human plasma by means of LC‐HRMS. Drug Test Anal 2020; 12:382-390. [DOI: 10.1002/dta.2765] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Andreas Thomas
- Institute of Biochemistry/Center for Preventive Doping Research German Sport University Cologne Cologne Germany
| | - Rouxue Yang
- Institute of Biochemistry/Center for Preventive Doping Research German Sport University Cologne Cologne Germany
| | - Simon Petring
- Institute of Biochemistry/Center for Preventive Doping Research German Sport University Cologne Cologne Germany
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research German Sport University Cologne Cologne Germany
- European Monitoring Center for Emerging Doping Agents (EuMoCEDA) Cologne/Bonn Germany
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