Direct determination of free bilirubin in serum at sub-nanomolar levels

Simultaneous determination of free biliverdin and free bilirubin in serum: A comprehensive LC-MS approach

BACKGROUND

Prognosis, diagnosis, and treatment of several diseases strongly rely on the sensitive, selective, and accurate determination of specific biomarkers in relevant biological samples. Free biliverdin and free bilirubin represent important new biomarkers of oxidative stress, however, the lack of suitable analytical methods for their determination has hindered progress in biomedical and clinical research.

RESULTS

Here, we introduce a first comprehensive approach for robust and simultaneous determination of these bilins in serum using liquid chromatography - mass spectrometry (LC-MS). The developed analytical method exhibits linearity for both analytes within the concentration range of 0.5-100 nM, with limits of detection and quantitation determined at 0.1 nM and 0.5 nM, respectively. Moreover, several analytical pitfalls related to the intrinsic molecular structures of free bilirubin and free biliverdin and their trace concentration levels in biological samples are discussed here in detail for the first time. We have shown that the solubility, chemical stability, and affinity of these bilins to various materials strongly depend on the solvent, pH, and addition of stabilizing and chelating agents. Finally, the validated LC-MS method was successfully applied to the analysis of both bilins in fetus bovine serums, yielding higher free bilirubin/biliverdin ratios compared with previously reported values for human serum.

SIGNIFICANCE

Failure to recognize and address the challenges presented here often leads to substantial analytical errors and consequently biased interpretation of the obtained results. This pertains not only to LC-MS, but also to many other analytical platforms due to the compound-derived sources of error.

Selective and sensitive fluorescence turn-on detection of bilirubin using resorcinol-sucrose derived carbon dot

Carbon dots have been prepared from resorcinol and sucrose (rsCDs) hydrothermally, which show green emission at 525 nm with a fluorescence quantum yield (PLQY) of 17.2%. The intense emission of rsCDs is quenched upon the addition of Cu²⁺. In the presence of bilirubin (BR), the emission intensity is enhanced due to the competitive binding of Cu²⁺ with bilirubin and hence releasing rsCDs to the sensing medium. It is the first time report on turn-on fluorescence sensing towards BR with a detection limit of 85 nM. Even in the presence of other comparable biomolecules, the sensor is selective and ultrasensitive to bilirubin. A cellulose paper-based sensor strip has also been designed for the naked-eye detection of BR in blood serum. Due to the specific recognition of this rsCDs towards BR, it can be applied to detect BR in practical human serum samples.

The effect of different intravenous lipids on free bilirubin levels in premature infants

BACKGROUND

Intravenous lipid emulsions are commonly used as a part of parenteral nutrition in premature infants. The potential bilirubin-displacing effects of high free fatty acid (FFA) levels during lipid infusions are known. Levels of free bilirubin (FB) predict the risk of bilirubin neurotoxicity more accurately than indirect serum bilirubin levels. In the present study, we decided to compare the effect of two different lipid solutions on free bilirubin and free fatty acids levels in premature infants.

METHODS

Infants were grouped into two groups according to intravenous lipid preparations: Infants in Group 1 received lipid emulsion containing olive oil + soybean oil and Group 2 received containing olive oil + soybean oil + fish oil. The blood samples were gained when lipid intake was 3.5 g/kg/day and FFA and FB levels were analyzed.

RESULTS

Serum FFA and FB levels were similar in groups (p = 0.26 and 0.69 respectively). There were significant correlation between serum FFA and FB levels in Group 1 (r = 0.74, p < 0.001) and in Group 2 (r = 0.92, p < 0.001).

CONCLUSION

Both lipid preparations seem to have similar effects on free bilirubin and free fatty acid levels in premature newborns.

Fluorescent sensing of free bilirubin at nanomolar level using a Langmuir-Blodgett film of glucuronic acid-functionalized gold nanoclusters

Serum bilirubin is an important indicator to assess liver function and diagnose various types of liver diseases. The level of serum bilirubin is also negatively correlated with the risk of cardiovascular disease and cancer. We had fabricated a fluorescent film sensor aiming at free bilirubin detection at the nanomolar level. Gold nanoclusters capped by human serum albumin (HSA-AuNCs) were utilized as a fluorescent platform for bilirubin biorecognition. HSA-AuNCs were functionalized with glucuronic acid to increase the binding sites for bilirubin. An ultrathin film of glucuronic acid-functionalized gold nanoclusters was obtained by the Langmuir-Blodgett (LB) technique. When exposed to bilirubin, the interaction between free bilirubin and the functionalized AuNCs resulted in fluorescent quenching of the film. Good linearity could be achieved for the quenching efficiency versus the logarithm of free bilirubin concentration over a concentration range of 1.00 nM~5.00 μM. The limit of detection (LOD) was calculated to be (2.70 ± 0.14) × 10^-1 nM (S/N = 3). The film sensor presents a good anti-interference capability towards common substances coexisting with bilirubin in serum. Satisfactory results achieved in the tests of real serum samples indicate that the LB film sensor can be used for bilirubin determination in nanomolar concentration.

Aggregation-induced emission enhancement of gold nanoclusters in metal-organic frameworks for highly sensitive fluorescent detection of bilirubin

A fluorescence analysis method based on gold nanocluster (AuNC) and metal-organic framework (MOF) composite materials (AuNCs@ZIF-8) was established for highly sensitive detection of bilirubin (BR). First, AuNCs@ZIF-8 was successfully obtained by co-precipitation and displayed an aggregation-induced emission enhancement by the confinement effect of the MOFs (i.e., ZIF-8). The product showed approximately 7.0 times enhancement in the quantum yield and longer fluorescence lifetime from 2.29 μs to 11.51 μs compared with AuNCs. When BR combined with the metal node Zn2+ of ZIF-8, the skeleton of the composite was destroyed, leading to a great decrease in the fluorescence intensity by the transformation of the AuNCs from the aggregated state to dispersed state. The linear range for the detection of BR was 0.1-5.0 μM, with the limit of detection (LOD) of 0.07 μM (S/N = 3). The AuNCs@ZIF-8 exhibited a selective response toward BR within 5 min and detected BR in human serum. The long-wavelength emission by AuNCs avoided the interference of the complex biomatrix background fluorescence, indicating their great application prospects for clinical diagnosis.

SERUM BILIRUBIN CORRELATES WITH SERUM ADIPOKINES IN NORMAL WEIGHT AND OVERWEIGHT ASYMPTOMATIC ADULTS

Overweight and obesity are considered as chronic low-grade inflammation accompanied by imbalanced production of adipokines. The aim of this study was to elucidate the relationship between serum bilirubin, which is an endogenous antioxidant with anti-inflammatory activity, and pro- and anti-inflammatory serum adipokines in asymptomatic normal weight and overweight individuals. Healthy men and women aged 25-49 participated in this cross-sectional study. All participants underwent fasting serological measurements of adipokines, interleukin-6, tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), total and direct serum bilirubin, and other biochemical parameters. Participants were divided into normal weight and overweight groups. We found a significant negative association between total bilirubin and CRP, TNF-α, visfatin and resistin values, and a significant positive association between total bilirubin and adiponectin values in both normal-weight and overweight groups. Importantly, after adjusting for body mass index, we also found a significant negative association between total serum bilirubin levels and both visfatin and CRP serum levels. Moreover, visfatin, resistin and CRP were predictors of the total serum bilirubin levels.

Easy Diagnosis of Jaundice: A Smartphone-Based Nanosensor Bioplatform Using Photoluminescent Bacterial Nanopaper for Point-of-Care Diagnosis of Hyperbilirubinemia

One of the concerns of parents in the first days of their baby's birth is the baby's risk of jaundice/hyperbilirubinemia. This is because more than 60% of babies are born with jaundice that, if not timely diagnosed and subsequently treated, can lead to serious damage to their health. On the other hand, despite recent progress in sensor technology for clinical applications, the development of easy-to-use, cost-effective, sensitive, specific, and portable diagnostic devices, which use nontoxic and biodegradable materials in their design and fabrication, is still in high demand. Herein we present an easy-to-use, cost-effective, selective, nontoxic, and disposable photoluminescent nanopaper-based assay kit with a smartphone readout for easy diagnosis of neonatal jaundice through visual determination of Bilirubin (BR) in infants' blood samples. The developed BR assay kit comprises highly photoluminescent carbon dot (CD) sensing probes embedded in a bacterial cellulose (BC) nanopaper substrate (CDBN). The photoluminescence (PL) of the developed BR sensor is quenched in the presence of BR as a PL quencher and then selectively recovered upon blue light (λ = 470 nm) exposure, due to conversion of the unconjugated BR to the colorless oxidation products (non-PL quencher) through BR photoisomerization and photooxidation, that subsequently leads to selective PL enhancement of CDBN. The recovered PL intensity of the developed BR assay kit, which was monitored by integrated smartphone camera, was linearly proportional to the concentration of BR in the range of 2-20 mg dL^-1. The feasibility of real application of the fabricated smartphone-based BR assay kit was also confirmed via comparing the results of our method with a clinical reference method for determination of BR concentration in infant's blood samples. With the advantages of nontoxicity and the extraordinary physicochemical properties of photoluminescent BC nanopaper as the sensing substrate, along with those of smartphone technology, we believe that our developed smartphone-based BR assay kit, as an easy-to-use, cost-effective (∼0.01 Euro per test), portable and novel sensing bioplatform, can be potentially exploited for sensitive, specific, rapid, and easy BR detection and jaundice diagnosis at the point of care (POC) and in routine clinical laboratories as well.

A Gold Nanoclusters Film Supported on Polydopamine for Fluorescent Sensing of Free Bilirubin

Serum bilirubin is an important biomarker for the diagnosis of various types of liver diseases and blood disorders. A polydopamine/gold nanoclusters composite film was fabricated for the fluorescent sensing of free bilirubin. Bovine serum albumin (BSA)-stabilized gold nanoclusters (AuNCs) were used as probes for biorecognition. The polydopamine film was utilized as an adhesion layer for immobilization of AuNCs. When the composite film was exposed to free bilirubin, due to the complex that was formed between BSA and free bilirubin, the fluorescence intensity of the composite film was gradually weakened as the bilirubin concentration increased. The fluorescence quenching ratio (F₀/F) was linearly proportional to free bilirubin over the concentration range of 0.8~50 μmol/L with a limit of detection of 0.61 ± 0.12 μmol/L (S/N = 3). The response was quick, the film was recyclable, and common ingredients in human serum did not interfere with the detection of free bilirubin.

Development of new methods for determination of bilirubin

The ever-increasing demand for a sensitive, rapid and reliable method for determination of serum bilirubin level has been inciting the interest of the researchers to develop new methods for both laboratory set up and point of care applications. These efforts embrace measurement of different forms of bilirubin, such as, unconjugated (free and albumin bound) bilirubin, conjugated (direct) bilirubin, and total (both conjugated and unconjugated) bilirubin in the serum that may provide critical information useful for diagnosis of many diseases and metabolic disorders. Herein, an effort has been made to provide a broad overview on the subject starting from the conventional spectroscopy based analytical methods widely practiced in the laboratory setup along with the sophisticated instrument based sensitive methods suitable for determination of different forms of bilirubin to various portable low cost systems applicable in point of care (POC) settings. In all these discussions emphasis is given on the novel methods and techniques bearing potential to measure the bilirubin level in biological samples reliably with less technical complexity and cost. We expect that this review will serve as a ready reference for the researchers and clinical professionals working on the subject and allied fields.

Selective non-enzymatic total bilirubin detection in serum using europium complexes with different β-diketone-derived ligands as luminescence probes

Three europium(III) complexes, Eu(ectfd)₃ (Hectfd = 1-(9-ethyl-9H-carbazol-7-yl)-4,4,4-trifluorobutane-1,3-dione), Eu(tta)₃ (Htta = 4,4,4-trifluoro-1-(thiophen-2-yl)-butane-1,3-dione), and Eu(dbt)₃ (Hdbt = 2-(4',4',4'-trifluoro-1',3'-dioxobutyl)dibenzothiophene), were synthesized and employed to detect total bilirubin (BR) in blood-serum samples. UV-visible absorption and fluorescence (FL) spectroscopies were used to evaluate the selectivity of each europium (III) fluorescence probe to BR, which was shown to remarkably reduce the luminescence intensities of the europium(III) complexes at a wavelength of 612 nm. The luminescence intensity of each complex is linearly related to BR concentration. Eu(tta)₃ was shown to be the more-appropriate fluorescence probe for the sensitive and reliable detection of total BR in blood serum samples than either Eu(ectfd)₃ or Eu(dbt)₃. This observation can be ascribed to special σ-hole bonding between Htta and BR. In addition, the optimal pH test conditions for the detection of BR in human serum by the Eu(tta)₃ probe were determined. Sensitivity was shown to be dramatically affected by the pH of the medium. The experimental results reveal that pH 7.5 is optimal for this probe, which coincides with the pH of human serum. Furthermore, BR detection using the Eu(tta)₃ luminescence probe is simple, practical, and relatively free of interference from coexisting substances; it has a minimum detection limit (DL) of 68 nM and is a potential candidate for the routine assessment of total BR in serum samples. Graphical Abstract ᅟ.

The fluorescence quenching of Ru(bipy)32+ : an application for the determination of bilirubin in biological samples

A simple, sensitive and efficient fluorescence method has been established for the quantitative analysis of bilirubin. The fluorometric determination method was based on the kinetic quenching of ruthenium(II) fluorescence. The quenching effect may be due to the complexation reaction of bilirubin with ruthenium(II). Therefore, the effects of ruthenium concentrations and different surfactants have been studied. Under the optimized experimental parameters, the fluorescence intensity decreased proportionally with the bilirubin concentration and linearity was established in the range of 3.3 × 10^-7 to 3.0 × 10^-4  M bilirubin. The detection limit calculated from the calibration graph was found to be 5.2 × 10^-8  M. The relative standard deviation (RSD) of 10 consecutive measurements of 8.0 × 10^-6  M bilirubin was 3.0%, while the recoveries of bilirubin in both human serum and urine samples were obtained in the range 94.0-99.5%. The interference study shows that the developed fluorescence based technique is fast, easy to carry out and shows negligible interference. The developed technique was successfully applied for the analysis of bilirubin in human urine and serum samples. All the experimental results and quality parameters confirmed the sensitivity and reproducibility of the proposed technique for bilirubin determination in human urine and serum samples.

Sensitive detection of free bilirubin in blood serum using β-diketone modified europium-doped yttrium oxide nanosheets as a luminescent sensor

Free bilirubin, when present in excess in the human body, can cause a multitude of diseases and disorders and even be fatal; hence, detecting it is of paramount importance. Herein, we report a luminescence quenching-based non-enzymatic method for the convenient, reliable, and rapid detection of free bilirubin in blood serum samples using sensing films (nanosheets/PS, nanosheets-tta/PS, and nanosheets-dbt/PS) as luminescent sensors. The luminescence intensity of the sensing films is linearly related to the free bilirubin concentration. Nanosheets-tta/PS demonstrated excellent sensing properties for the sensitive and reliable detection of free bilirubin in the range of 0.0–60.0 μM with a correlation coefficient of 0.9915, as compared to nanosheets/PS or nanosheets-dbt/PS. The limit of detection for the determination of free bilirubin was 41 nM. This method can be used to design a sensor-based test spot as a medical detection device for the visual detection of free bilirubin.

Free bilirubin, when present in excess in the human body, can cause a multitude of diseases and disorders and even be fatal; hence, detecting it is of paramount importance.

Bilirubin is an Endogenous Antioxidant in Human Vascular Endothelial Cells

Bilirubin is a standard serum biomarker of liver function. Inexplicably, it is inversely correlated with cardiovascular disease risk. Given the role of endothelial dysfunction in originating cardiovascular diseases, direct analysis of bilirubin in the vascular endothelium would shed light on these relationships. Hence, we used high-performance liquid chromatography coupled with thermal lens spectrometric detection and diode array detection for the determination of endogenous cellular IXα-bilirubin. To confirm the isomer IXα-bilirubin, we used ultra-performance liquid chromatography coupled with a high-resolution mass spectrometer using an electrospray ionization source, as well as tandem mass spectrometric detection. We measured bilirubin in both arterial and venous rat endothelium (0.9-1.5 pmol mg(-1) protein). In the human endothelial Ea.hy926 cell line, we demonstrated that intracellular bilirubin (3-5 pmol mg(-1) protein) could be modulated by either extracellular bilirubin uptake, or by up-regulation of heme oxygenase-1, a cellular enzyme related to endogenous bilirubin synthesis. Moreover, we determined intracellular antioxidant activity by bilirubin, with EC50 = 11.4 ± 0.2 nM, in the range of reported values of free serum bilirubin (8.5-13.1 nM). Biliverdin showed similar antioxidant properties as bilirubin. We infer from these observations that intra-endothelial bilirubin oscillates, and may thus be a dynamic factor of the endothelial function.