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Müller FA, Stamou M, Englert FH, Frenzel O, Diedrich S, Suter-Dick L, Wambaugh JF, Sturla SJ. In vitro to in vivo extrapolation and high-content imaging for simultaneous characterization of chemically induced liver steatosis and markers of hepatotoxicity. Arch Toxicol 2023; 97:1701-1721. [PMID: 37046073 PMCID: PMC10182956 DOI: 10.1007/s00204-023-03490-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
Chemically induced steatosis is characterized by lipid accumulation associated with mitochondrial dysfunction, oxidative stress and nucleus distortion. New approach methods integrating in vitro and in silico models are needed to identify chemicals that may induce these cellular events as potential risk factors for steatosis and associated hepatotoxicity. In this study we used high-content imaging for the simultaneous quantification of four cellular markers as sentinels for hepatotoxicity and steatosis in chemically exposed human liver cells in vitro. Furthermore, we evaluated the results with a computational model for the extrapolation of human oral equivalent doses (OED). First, we tested 16 reference chemicals with known capacities to induce cellular alterations in nuclear morphology, lipid accumulation, mitochondrial membrane potential and oxidative stress. Then, using physiologically based pharmacokinetic modeling and reverse dosimetry, OEDs were extrapolated from data of any stimulated individual sentinel response. The extrapolated OEDs were confirmed to be within biologically relevant exposure ranges for the reference chemicals. Next, we tested 14 chemicals found in food, selected from thousands of putative chemicals on the basis of structure-based prediction for nuclear receptor activation. Amongst these, orotic acid had an extrapolated OED overlapping with realistic exposure ranges. Thus, we were able to characterize known steatosis-inducing chemicals as well as data-scarce food-related chemicals, amongst which we confirmed orotic acid to induce hepatotoxicity. This strategy addresses needs of next generation risk assessment and can be used as a first chemical prioritization hazard screening step in a tiered approach to identify chemical risk factors for steatosis and hepatotoxicity-associated events.
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Affiliation(s)
- Fabrice A Müller
- Department of Health Sciences and Technology, ETH Zurich, Schmelzbergstrasse 9, 8092, Zurich, Switzerland
| | - Marianna Stamou
- Department of Health Sciences and Technology, ETH Zurich, Schmelzbergstrasse 9, 8092, Zurich, Switzerland
| | - Felix H Englert
- Department of Health Sciences and Technology, ETH Zurich, Schmelzbergstrasse 9, 8092, Zurich, Switzerland
| | - Ole Frenzel
- Department of Health Sciences and Technology, ETH Zurich, Schmelzbergstrasse 9, 8092, Zurich, Switzerland
| | - Sabine Diedrich
- Department of Health Sciences and Technology, ETH Zurich, Schmelzbergstrasse 9, 8092, Zurich, Switzerland
| | - Laura Suter-Dick
- School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, 4132, Muttenz, Switzerland
- Swiss Centre for Applied Human Toxicology (SCAHT), 4001, Basel, Switzerland
| | - John F Wambaugh
- Center for Computational Toxicology and Exposure, Office of Research and Development, United States Environmental Protection Agency, Research Triangle Park, Durham, NC, 27711, USA
| | - Shana J Sturla
- Department of Health Sciences and Technology, ETH Zurich, Schmelzbergstrasse 9, 8092, Zurich, Switzerland.
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Kilgore M, Platis D, Lim T, Isenberg S, Pickens CA, Cuthbert C, Petritis K. Development of a Universal Second-Tier Newborn Screening LC-MS/MS Method for Amino Acids, Lysophosphatidylcholines, and Organic Acids. Anal Chem 2023; 95:3187-3194. [PMID: 36724346 PMCID: PMC9933048 DOI: 10.1021/acs.analchem.2c03098] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
First-tier MS-based newborn screening by flow injection analysis can have high presumptive positive rates, often due to isomeric/isobaric compounds or poor biomarker specificity. These presumptive positive samples can be analyzed by second-tier screening assays employing separations such as liquid chromatography-mass spectrometry (LC-MS/MS), which increases test specificity and drastically reduces false positive referrals. The ability to screen for multiple disorders in a single multiplexed test simplifies workflows and maximizes public health laboratories' resources. In this study, we developed and validated a highly multiplexed second-tier method for dried blood spots using a hydrophilic interaction liquid chromatography (HILIC) column coupled to an MS/MS system. The LC-MS/MS method was capable of simultaneously detecting second-tier biomarkers for maple syrup urine disease, homocystinuria, methylmalonic acidemia, propionic acidemia, glutaric acidemia type 1, glutaric acidemia type 2, guanidinoacetate methyltransferase deficiency, short-chain acyl-CoA dehydrogenase deficiency, adrenoleukodystrophy, and Pompe disease.
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Affiliation(s)
- Matthew
B. Kilgore
- Newborn
Screening and Molecular Biology Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Dimitrios Platis
- Department
of Newborn Screening, Institute of Child
Health, Athens 115 26, Greece
| | - Timothy Lim
- Newborn
Screening and Molecular Biology Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Samantha Isenberg
- Newborn
Screening and Molecular Biology Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - C. Austin Pickens
- Newborn
Screening and Molecular Biology Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Carla Cuthbert
- Newborn
Screening and Molecular Biology Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States
| | - Konstantinos Petritis
- Newborn
Screening and Molecular Biology Branch, US Centers for Disease Control and Prevention, Atlanta, Georgia 30341, United States,
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Staretz-Chacham O, Daas S, Ulanovsky I, Blau A, Rostami N, Saraf-Levy T, Abu Salah N, Anikster Y, Banne E, Dar D, Dumin E, Fattal-Valevski A, Falik-Zaccai T, Hershkovitz E, Josefsberg S, Khammash H, Keidar R, Korman SH, Landau Y, Lerman-Sagie T, Mandel D, Mandel H, Marom R, Morag I, Nadir E, Yosha-Orpaz N, Pode-Shakked B, Pras E, Reznik-Wolf H, Saada A, Segel R, Shaag A, Shaul Lotan N, Spiegel R, Tal G, Vaisid T, Zeharia A, Almashanu S. The role of orotic acid measurement in routine newborn screening for urea cycle disorders. J Inherit Metab Dis 2021; 44:606-617. [PMID: 33190319 DOI: 10.1002/jimd.12331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022]
Abstract
Urea cycle disorders (UCDs), including OTC deficiency (OTCD), are life-threatening diseases with a broad clinical spectrum. Early diagnosis and initiation of treatment based on a newborn screening (NBS) test for OTCD with high specificity and sensitivity may contribute to reduction of the significant complications and high mortality. The efficacy of incorporating orotic acid determination into routine NBS was evaluated. Combined measurement of orotic acid and citrulline in archived dried blood spots from newborns with urea cycle disorders and normal controls was used to develop an algorithm for routine NBS for OTCD in Israel. Clinical information and genetic confirmation results were obtained from the follow-up care providers. About 1147986 newborns underwent routine NBS including orotic acid determination, 25 of whom were ultimately diagnosed with a UCD. Of 11 newborns with OTCD, orotate was elevated in seven but normal in two males with early-onset and two males with late-onset disease. Orotate was also elevated in archived dried blood spots of all seven retrospectively tested historical OTCD patients, only three of whom had originally been identified by NBS with low citrulline and elevated glutamine. Among the other UCDs emerge, three CPS1D cases and additional three retrospective CPS1D cases otherwise reported as a very rare condition. Combined levels of orotic acid and citrulline in routine NBS can enhance the detection of UCD, especially increasing the screening sensitivity for OTCD and differentiate it from CPS1D. Our data and the negligible extra cost for orotic acid determination might contribute to the discussion on screening for proximal UCDs in routine NBS.
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Affiliation(s)
- Orna Staretz-Chacham
- Metabolic Clinic, Pediatric Division, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - Suha Daas
- National Newborn Screening Program, Ministry of Health, Tel-HaShomer, Ramat Gan, Israel
| | - Igor Ulanovsky
- National Newborn Screening Program, Ministry of Health, Tel-HaShomer, Ramat Gan, Israel
| | - Ayala Blau
- National Newborn Screening Program, Ministry of Health, Tel-HaShomer, Ramat Gan, Israel
- Nursing Department, School of Health Sciences, Ariel University, Ariel, Israel
| | - Nira Rostami
- National Newborn Screening Program, Ministry of Health, Tel-HaShomer, Ramat Gan, Israel
| | - Talya Saraf-Levy
- National Newborn Screening Program, Ministry of Health, Tel-HaShomer, Ramat Gan, Israel
| | - Nasser Abu Salah
- Department of Neonatology, Red Crescent Society Hospital, Jerusalem, Israel
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yair Anikster
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ehud Banne
- Genetics Institute, Kaplan Medical Center, Rehovot, Israel
| | - Dalit Dar
- Department of Clinical Biochemistry, Rambam Health Care Campus, Haifa, Israel
| | - Elena Dumin
- Department of Clinical Biochemistry, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Aviva Fattal-Valevski
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Dana Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tzipora Falik-Zaccai
- Institute of Human Genetics, The Galilee Medical Center, Naharia, Israel
- The Azrieli Faculty of Medicine, Bar Ilan, Israel
| | - Eli Hershkovitz
- Pediatric D Department, Soroka Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | | | - Hatem Khammash
- Department of Neonatology, Makassed Islamic Hospital, Jerusalem, Israel
| | - Rimona Keidar
- Pediatric Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stanley H Korman
- Wilf Children's Hospital, Shaare Zedek Medical Center, Jerusalem, Israel
- Metabolic Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Landau
- Metabolic Disease Unit, Schneider Children's Medical Center of Israel, Tel Aviv University, Israel
| | - Tally Lerman-Sagie
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
| | - Dror Mandel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Hanna Mandel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Metabolic Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ronella Marom
- Department of Neonatology, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iris Morag
- Pediatric Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erez Nadir
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Naama Yosha-Orpaz
- Pediatric Neurology Unit, Metabolic Neurogenetic Service, Wolfson Medical Center, Holon, Israel
| | - Ben Pode-Shakked
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Elon Pras
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
- Department of Genetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haike Reznik-Wolf
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat Gan, Israel
| | - Ann Saada
- Department of Genetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University School of Medicine, Jerusalem, Israel
| | - Reeval Segel
- Hebrew University School of Medicine, Jerusalem, Israel
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Avraham Shaag
- Department of Genetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nava Shaul Lotan
- Department of Genetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronen Spiegel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Pediatrics B, Metabolic Service, Emek Medical Center, Afula, Israel
| | - Galit Tal
- Metabolic Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Taly Vaisid
- Metabolic Laboratory, Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
| | - Avi Zeharia
- Metabolic Disease Unit, Schneider Children's Medical Center of Israel, Tel Aviv University, Israel
| | - Shlomo Almashanu
- National Newborn Screening Program, Ministry of Health, Tel-HaShomer, Ramat Gan, Israel
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Wagner M, Tonoli D, Varesio E, Hopfgartner G. The use of mass spectrometry to analyze dried blood spots. MASS SPECTROMETRY REVIEWS 2016; 35:361-438. [PMID: 25252132 DOI: 10.1002/mas.21441] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Dried blood spots (DBS) typically consist in the deposition of small volumes of capillary blood onto dedicated paper cards. Comparatively to whole blood or plasma samples, their benefits rely in the fact that sample collection is easier and that logistic aspects related to sample storage and shipment can be relatively limited, respectively, without the need of a refrigerator or dry ice. Originally, this approach has been developed in the sixties to support the analysis of phenylalanine for the detection of phenylketonuria in newborns using bacterial inhibition test. In the nineties tandem mass spectrometry was established as the detection technique for phenylalanine and tyrosine. DBS became rapidly recognized for their clinical value: they were widely implemented in pediatric settings with mass spectrometric detection, and were closely associated to the debut of newborn screening (NBS) programs, as a part of public health policies. Since then, sample collection on paper cards has been explored with various analytical techniques in other areas more or less successfully regarding large-scale applications. Moreover, in the last 5 years a regain of interest for DBS was observed and originated from the bioanalytical community to support drug development (e.g., PK studies) or therapeutic drug monitoring mainly. Those recent applications were essentially driven by improved sensitivity of triple quadrupole mass spectrometers. This review presents an overall view of all instrumental and methodological developments for DBS analysis with mass spectrometric detection, with and without separation techniques. A general introduction to DBS will describe their advantages and historical aspects of their emergence. A second section will focus on blood collection, with a strong emphasis on specific parameters that can impact quantitative analysis, including chromatographic effects, hematocrit effects, blood effects, and analyte stability. A third part of the review is dedicated to sample preparation and will consider off-line and on-line extractions; in particular, instrumental designs that have been developed so far for DBS extraction will be detailed. Flow injection analysis and applications will be discussed in section IV. The application of surface analysis mass spectrometry (DESI, paper spray, DART, APTDCI, MALDI, LDTD-APCI, and ICP) to DBS is described in section V, while applications based on separation techniques (e.g., liquid or gas chromatography) are presented in section VI. To conclude this review, the current status of DBS analysis is summarized, and future perspectives are provided.
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Affiliation(s)
- Michel Wagner
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - David Tonoli
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - Emmanuel Varesio
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - Gérard Hopfgartner
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
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Held PK, Haynes CA, De Jesús VR, Baker MW. Development of an assay to simultaneously measure orotic acid, amino acids, and acylcarnitines in dried blood spots. Clin Chim Acta 2014; 436:149-54. [PMID: 24886687 PMCID: PMC4835024 DOI: 10.1016/j.cca.2014.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Orotic aciduria in the presence of hyperammonemia is a key indicator for a defect in the urea cycle, specifically ornithine transcarbamylase (OTC) deficiency. Current newborn screening (NBS) protocols can detect several defects of the urea cycle, but screening for OTC deficiency remains a challenge due to the lack of a suitable assay. The purpose of this study was to develop a high-throughput assay to measure orotic acid in dried blood spot (DBS) specimens as an indicator for urea cycle dysfunction, which can be readily incorporated into routine NBS. METHODS Orotic acid was extracted from DBS punches and analyzed using flow-injection analysis tandem mass spectrometry (FIA-MS/MS) with negative-mode ionization, requiring <2 min/sample run time. This method was then multiplexed into a conventional newborn screening assay for analysis of amino acids, acylcarnitines, and orotic acid. RESULTS We describe 2 assays which can quantify orotic acid in DBS: a stand-alone method and a combined method for analysis of orotic acid, amino acids, and acylcarnitines. Both methods demonstrated orotic acid recovery of 75-85% at multiple levels of enrichment. Precision was also comparable to traditional FIA-MS/MS methods. Analysis of residual presumptively normal NBS specimens demonstrated a 5:1 signal to noise ratio and the average concentration of orotic acid was approximately 1.2 μmol/l. The concentration of amino acids and acylcarnitines as measured by the combined method showed no significant differences when compared to the conventional newborn screening assay. In addition, retrospective analysis of confirmed patients and presumptively normal newborn screening specimens suggests potential for the methods to identify patients with OTC deficiency, as well as other urea cycle defects. CONCLUSION The assays described here quantify orotic acid in DBS using a simple extraction and FIA-MS/MS analysis procedures that can be implemented into current NBS protocols.
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Affiliation(s)
- Patrice K Held
- Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
| | - Christopher A Haynes
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States
| | - Víctor R De Jesús
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, United States
| | - Mei W Baker
- Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706, United States; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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