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Swart AC, van Rooyen D, du Toit T, Heyns B, Molphy J, Wilson M, Leahy R, Atkin SL. Circulating adrenal and gonadal steroid hormones heterogeneity in active young males and the contribution of 11-oxy androgens. Sci Rep 2024; 14:16226. [PMID: 39003307 PMCID: PMC11246537 DOI: 10.1038/s41598-024-66749-9] [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: 12/06/2023] [Accepted: 07/03/2024] [Indexed: 07/15/2024] Open
Abstract
The classical androgens, testosterone and dihydrotestosterone, together with dehydroepiandrosterone, the precusrsor to all androgens, are generally included in diagnostic steroid evaluations of androgen excess and deficiency disorders and monitored in androgen replacement and androgen suppressive therapies. The C11-oxy androgens also contribute to androgen excess disorders and are still often excluded from clinical and research-based steroids analysis. The contribution of the C11-oxy androgens to the androgen pool has not been considered in androgen deficiency. An exploratory investigation into circulating adrenal and gonadal steroid hormones in men was undertaken as neither the classical androgens nor the C11-oxy androgens have been evaluated in the context of concurrent measurement of all adrenal steroid hormones. Serum androgens, mineralocorticoids, glucocorticoids, progesterones and androgens were assessed in 70 healthy young men using ultra high performance supercritical fluid chromatography and tandem mass spectrometry. Testosterone, 24.5 nmol/L was the most prominent androgen detected in all participants while dihydrotestosterone, 1.23 nmol/L, was only detected in 25% of the participants. The 11-oxy androgens were present in most of the participants with 11-hydroxyandrostenedione, 3.37 nmol, in 98.5%, 11-ketoandrostenedione 0.764 in 77%, 11-hydroxytestosterone, 0.567 in 96% and 11-ketotestosterone: 0.440 in 63%. A third of the participants with normal testosterone and comparable 11-ketotestosterone, had significantly lower dehydroepiandrosterone (p < 0.001). In these males 11-hydroxyandrostenedione (p < 0.001), 11-ketoandrostenedione (p < 0.01) and 11-hydroxytestosterone (p < 0.006) were decreased. Glucocorticoids were also lower: cortisol (p < 0.001), corticosterone (p < 0.001), cortisone (p < 0.006) 11-dehydrocorticosterone (p < 0.001) as well as cortisol:cortisone (p < 0.001). The presence of dehydroepiandrosterone was associated with 16-hydroxyprogesterone (p < 0.001), which was also significantly lower. Adrenal and gonadal steroid analysis showed unexpected steroid heterogeneity in normal young men. Testosterone constitutes 78% of the circulating free androgens with the 11-oxy androgens abundantly present in all participants significantly contributing 22%. In addition, a subset of men were identified with low circulating dehydroepiandrosterone who showed altered adrenal steroids with decreased glucocorticoids and decreased C11-oxy androgens. Analysis of the classical and 11-oxy androgens with the additional measurement of dehydroepiandrosterone and 16-hydroxyprogesterone may allow better diagnostic accuracy in androgen excess or deficiency.
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Affiliation(s)
- Amanda C Swart
- Department of Biochemistry, Stellenbosch University, Stellenbosch, 7600, South Africa.
- Department of Chemistry and Polymer Science, Stellenbosch University, Stellenbosch, 7600, South Africa.
| | - Desmaré van Rooyen
- Department of Biochemistry, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Therina du Toit
- Department of Biochemistry, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Bianca Heyns
- Department of Biochemistry, Stellenbosch University, Stellenbosch, 7600, South Africa
- Department of Chemistry and Polymer Science, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - John Molphy
- Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Mathew Wilson
- Institute of Sport, Exercise and Health, University College London, London, WC1E 6BT, UK
| | - Roisin Leahy
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Stephen L Atkin
- Royal College of Surgeons in Ireland, Busaiteen, Bahrain
- Weill Cornell Medicine Qatar, Doha, Qatar
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Gent R, Van Rooyen D, Atkin SL, Swart AC. C11-hydroxy and C11-oxo C 19 and C 21 Steroids: Pre-Receptor Regulation and Interaction with Androgen and Progesterone Steroid Receptors. Int J Mol Sci 2023; 25:101. [PMID: 38203272 PMCID: PMC10778819 DOI: 10.3390/ijms25010101] [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: 11/08/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
C11-oxy C19 and C11-oxy C21 steroids have been identified as novel steroids but their function remains unclear. This study aimed to investigate the pre-receptor regulation of C11-oxy steroids by 11β-hydroxysteroid dehydrogenase (11βHSD) interconversion and potential agonist and antagonist activity associated with the androgen (AR) and progesterone receptors (PRA and PRB). Steroid conversions were investigated in transiently transfected HEK293 cells expressing 11βHSD1 and 11βHSD2, while CV1 cells were utilised for agonist and antagonist assays. The conversion of C11-hydroxy steroids to C11-oxo steroids by 11βHSD2 occurred more readily than the reverse reaction catalysed by 11βHSD1, while the interconversion of C11-oxy C19 steroids was more efficient than C11-oxy C21 steroids. Furthermore, 11-ketodihydrotestosterone (11KDHT), 11-ketotestosterone (11KT) and 11β-hydroxydihydrotestosterone (11OHDHT) were AR agonists, while only progestogens, 11β-hydroxyprogesterone (11βOHP4), 11β-hydroxydihydroprogesterone (11βOHDHP4), 11α-hydroxyprogesterone (11αOHP4), 11α-hydroxydihydroprogesterone (11αOHDHP4), 11-ketoprogesterone (11KP4), 5α-pregnan-17α-diol-3,11,20-trione (11KPdione) and 21-deoxycortisone (21dE) exhibited antagonist activity. C11-hydroxy C21 steroids, 11βOHP4, 11βOHDHP4 and 11αOHP4 exhibited PRA and PRB agonistic activity, while only C11-oxo steroids, 11KP4 and 11-ketoandrostanediol (11K3αdiol) demonstrated PRB agonism. While no steroids antagonised the PRA, 11OHA4, 11β-hydroxytestosterone (11OHT), 11KT and 11KDHT exhibited PRB antagonism. The regulatory role of 11βHSD isozymes impacting receptor activation is clear-C11-oxo androgens exhibit AR agonist activity; only C11-hydroxy progestogens exhibit PRA and PRB agonist activity. Regulation by the downstream metabolites of active C11-oxy steroids at the receptor level is apparent-C11-hydroxy and C11-oxo metabolites antagonize the AR and PRB, progestogens the former, androgens the latter. The findings highlight the intricate interplay between receptors and active as well as "inactive" C11-oxy steroids, suggesting novel regulatory tiers.
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Affiliation(s)
- Rachelle Gent
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa; (R.G.)
| | - Desmaré Van Rooyen
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa; (R.G.)
| | - Stephen L. Atkin
- School of Postgraduate Studies and Research, Royal College of Surgeons in Ireland Bahrain, Adliya 15503, Bahrain;
| | - Amanda C. Swart
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa; (R.G.)
- Department of Chemistry and Polymer Science, Stellenbosch University, Stellenbosch 7600, South Africa
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Yang G, Guo J, Yuan H, Sun L, Sha L. Determination of selected glucocorticoids in healthy foods by ultra-performance convergence chromatography-triple quadrupole mass spectrometry. J Chromatogr A 2023; 1694:463924. [PMID: 36933464 DOI: 10.1016/j.chroma.2023.463924] [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: 11/12/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
The presence of glucocorticoids in healthy foods has recently become a topic of concern because of their side effects. In this study, we developed a method based on ultra-performance convergence chromatography-triple quadrupole mass spectrometry (UPC2-MS/MS) to detect 63 glucocorticoids in healthy foods. The analysis conditions were optimized, and the method was validated. We further compared the results of this method with those of the RPLC-MS/MS method. Glucocorticoids were separated on an Acquity Torus 2-picolylamine column (100 mm × 3.0 mm, 1.7 µm) and detected via MS/MS. CO2 and methanol (containing 0.1% formic acid) were used as mobile phases. The method demonstrated good linear relationships between 1 and 200 µg·L-1 (R2 ≥ 0.996). The limits of detection in different types of samples were 0.3-1.5 µg·kg-1 (S/N = 3). The average recoveries (n = 9) and RSDs in different types of samples were 76.6-118.2% and 1.1-13.1%, respectively. The matrix effect, calculated as the ratio between calibration curves built in matrix and pure solvent, was less than 0.21 for both a fish oil and a protein powder. This method exhibited better selectivity and resolution than RPLC-MS/MS method. Lastly, it could realize the baseline separation of 31 isomers of 13 groups, including four groups of eight epimers. This study provides new technical support for assessing the risk of exposure to glucocorticoids in healthy foods.
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Affiliation(s)
- Guangyong Yang
- Xinjiang Uygur Autonomous Region Product Quality Supervision and Inspection Institute, Urumqi 830011, China.
| | - Jingxi Guo
- Xinjiang Uygur Autonomous Region Product Quality Supervision and Inspection Institute, Urumqi 830011, China
| | - Hui Yuan
- Xinjiang Uygur Autonomous Region Product Quality Supervision and Inspection Institute, Urumqi 830011, China
| | - Lei Sun
- Xinjiang Uygur Autonomous Region Product Quality Supervision and Inspection Institute, Urumqi 830011, China
| | - Lina Sha
- Urumqi Berun Tiancheng Electronic Technology Co., Ltd, Urumqi 830054, China.
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Sait STL, Survilienė V, Jüssi M, Gonzalez SV, Ciesielski TM, Jenssen BM, Asimakopoulos AG. Determination of steroid hormones in grey seal (Halichoerus grypus) blood plasma using convergence chromatography tandem mass spectrometry. Talanta 2023; 254:124109. [PMID: 36535212 DOI: 10.1016/j.talanta.2022.124109] [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: 09/07/2022] [Revised: 10/26/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
A hybrid solid phase extraction (HybridSPE) protocol tailored to ultra-performance convergence chromatography tandem mass spectrometry (UPC2-MS/MS) was developed for the determination of 19 steroid hormones in grey seal (Halichoerus grypus) blood plasma. In this study, the protocol demonstrated acceptable absolute recoveries ranging from 33 to 90%. The chromatographic separation was carried out using a gradient elution program with a total run time of 5 min. For most target analytes, the method repeatability ranged from 1.9 to 24% and the method limits of quantification (mLOQs) ranged from 0.03 to 1.67 ng/mL. A total of 9 plasma samples were analysed to demonstrate the applicability of the developed method, and 13 steroid hormones were quantified in grey seal pup plasma. The most prevalent steroids: cortisol, cortisone, corticosterone, 11-deoxycortisol, progesterone and 17α-hydroxyprogesterone were detected at concentrations in the range of 12.6-40.1, 7.10-24.2, 0.74-10.7, 1.06-5.72, 0.38-4.38 and <mLOQ - 1.01 ng/mL, respectively. To our knowledge, this is the first study to determine steroid hormones in the plasma of pinnipeds using convergence chromatography.
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Affiliation(s)
- Shannen Thora Lea Sait
- Department of Chemistry, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Vaida Survilienė
- Institute of Biosciences, Life Sciences Center, Vilnius University, Sauletekio Av. 7, Vilnius, Lithuania
| | - Mart Jüssi
- Pro Mare MTÜ, Saula, Kose, Harjumaa, 75101, Estonia
| | - Susana V Gonzalez
- Department of Chemistry, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Tomasz Maciej Ciesielski
- Department of Biology, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway
| | - Bjørn Munro Jenssen
- Department of Biology, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway; Department of Arctic Technology, The University Centre in Svalbard (UNIS), P.O. Box 156, 9171, Longyearbyen, Norway; Department of Ecoscience, Aarhus University, P.O. Box 358, 4000, Roskilde, Denmark
| | - Alexandros G Asimakopoulos
- Department of Chemistry, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.
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Gent R, Barbier ID, Atkin SL, Newell-Fugate AE, Swart AC. Ultra-performance convergence chromatography tandem mass spectrometry analysis of adrenal and gonadal steroid hormones in southern white rhinoceros(Ceratotherium simum simum) faeces and serum. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1215:123576. [PMID: 36529070 DOI: 10.1016/j.jchromb.2022.123576] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
Steroid hormone analysis is routinely undertaken in the assessment of stress response and reproductive function in the management of both captive and free-ranging wildlife species. Faecal samples have become the preferred sample type for analysis as collection is non-invasive and easily assessable. These investigations are generally aimed at aiding successful translocations, enhanced survival outcomes in captivity and improvement of reproductive rate. Immunoassays are the most common approach in the analysis of hormones, particularly in the case of the southern white rhinoceros (Ceratotherium simum simum). Non-specificity, attributed to structural similarity of steroid metabolites impedes accurate evaluations which can be eliminated by chromatographic techniques which are more specific, selective and provide comprehensive analyses. This study developed and validated three methods using ultra-performance convergence chromatography tandem mass spectrometry for the assessment of classical androgens, progestogens and adrenal steroids, as well as the C11-oxy androgens and C11-oxy progestogens in serum and faeces from white rhinoceros. The limit of detection and quantification were determined for each steroid, parameters such as accuracy (<19.8 % RSD) and precision (<20.2 % RSD) were established with recovery, matrix effect, and process efficiency within acceptable limits. Subsequent analysis of serum and faecal samples from five white rhinoceros identified novel steroids for the first time in this species. In addition to the classical adrenal steroids, the following C11-oxy steroids were detected in faecal samples: 11α-hydroxydihydroprogesterone (168 ng/g), 11α-hydroxyprogesterone (125.9 ng/g), 11β-hydroxyprogesterone (210.2 ng/g) and 11-ketoandrostenedione (3.3-19.6 ng/g) with 11-deoxycortisol being the major glucocorticoid (24.2-67.3 ng/g) together with 21-deoxycortisone (40.7 ng/g) and deoxycorticosterone (7.6-14.6 ng/g). In serum samples 11β-hydroxyandrostenedione (0.35-2.34 ng/mL) and 11β-hydroxytestosterone (0.18-1.62 ng/mL) were the predominant androgens with cortisol (5.8-20.5 ng/mL), the predominant glucocorticoid, while corticosterone, 18-hydroxycorticosterone and aldosterone were also detected. These methods can be applied independently to assess either androgens, progestogens, or adrenal steroid panels or in combination to assess the cohort of gonadal and adrenal steroids in faeces and/or serum, in southern white rhinoceros as well as other wildlife species. Analysis would enable the accurate assessment of reproductive health and stress responses while also distinguishing between stress and distress thus contributing to the conservation of wildlife species.
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Affiliation(s)
- Rachelle Gent
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Inge D Barbier
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Stephen L Atkin
- Royal College of Surgeons in Ireland Bahrain, Adliya, Bahrain
| | - Annie E Newell-Fugate
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, TX 77843, United States
| | - Amanda C Swart
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600, South Africa; Department of Chemistry and Polymer Science, Stellenbosch University, Stellenbosch 7600, South Africa.
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Kothmann KH, Jons A, Wilhelmi B, Kasozi N, Graham L, Gent R, Atkin SL, Swart AC, Newell-Fugate AE. Non-invasive assessment of fecal glucocorticoid, progesterone, and androgen metabolites and microbiome in free-ranging southern white rhinoceros (Ceratotherium simum simum) in South Africa. Gen Comp Endocrinol 2022; 329:114099. [PMID: 35914652 DOI: 10.1016/j.ygcen.2022.114099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
Abstract
Increased poaching in northern South Africa has necessitated relocation of large numbers of southern white rhinoceros (Ceratotherium simum simum) to the Eastern Cape Province. The climate and grassland ecology of this province differ from that of northern South Africa which may impact the health of this species. This assessment of fecal steroid levels and microbiome in 10 free-ranging southern white rhinoceros in the Eastern Cape will provide insights into white rhinoceros physiology in this biome. Fecal steroid metabolites were analyzed using enzyme immunoassay (EIA) and ultra-performance convergence chromatography tandem mass spectrometry (UPC2-MS/MS). Fecal microbial composition was assessed via next generation sequencing. EIAs with antibodies raised against progesterone (P4; mouse monoclonal - CL425 clone), testosterone (T; rabbit polyclonal), corticosterone (B; sheep polyclonal) were utilized. Pregnant females had large quantities of fecal progesterone metabolites (FPMs) detected by CL425 EIA. Pregnant females also had native P4 and 11α-hydroxydihydroprogesterone (11αOHDHP4; 4-pregnen-11α-ol-3,20-dione) detected by UPC2-MS/MS but these concentrations were 1000-fold less than the concentrations of FPMs detected by the CL425 EIA. By contrast, non-pregnant females had FPM concentrations detected by CL425 EIA which were similar to native P4 and 11αOHDHP4 concentrations detected by UPC2-MS/MS. Mean fecal androgen metabolite (FAM) concentrations detected by the T EIA were similar between males and females. 11-ketoandrostenedione (11KA4) detected by UPC2-MS/MS was higher in females than males. However, there was no difference between males and females in the concentration of fecal glucocorticoid metabolites (FGMs) detected by the B EIA. Bacteroidia, followed by Clostridia, was the most abundant classes of fecal microbes. The unfiltered microbiome of females was more diverse than that of males. The core fecal microbiome of young rhinoceros had a higher observed species richness (Shannon diversity index, and Simpson diversity index) than that of old rhinoceros. In the alpha male, immobilization was associated with an increase in FGMs detected by 11-deoxycortisol (S) detected by UPC2-MS/MS coupled with decreased abundance of Spirochaetia. We detected substantially different FAM and FPM concentrations from those previously reported for both captive and wild white rhinoceros. Comparison of our UPC2-MS/MS and EIA results underscores the fact that most EIAs are highly cross reactive for many steroid metabolites. Our data also demonstrates a distinct effect of stress not only on FGMs but also on the fecal microbiome. This is the first non-invasive assessment of fecal steroid metabolites by UPC2-MS/MS and the fecal microbiome in wild white rhinoceros.
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Affiliation(s)
- K H Kothmann
- Department of Veterinary Physiology and Pharmacology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - A Jons
- Department of Molecular and Cellular Medicine, Health Science Center, Texas A&M University, College Station, TX 77843, USA
| | - B Wilhelmi
- Department of Biochemistry and Microbiology, Rhodes University, Grahamstown, 6140 South Africa
| | - N Kasozi
- Department of Biochemistry and Microbiology, Rhodes University, Grahamstown, 6140 South Africa
| | - L Graham
- Ikahala Veterinary Wildlife Services, Paterson 6131 South Africa
| | - R Gent
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600 South Africa
| | - S L Atkin
- Royal College of Surgeons in Ireland, Bahrain
| | - A C Swart
- Department of Biochemistry, Stellenbosch University, Stellenbosch 7600 South Africa; Department of Chemistry and Polymer Science, Stellenbosch University, Stellenbosch 7600 South Africa
| | - A E Newell-Fugate
- Department of Veterinary Physiology and Pharmacology, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA.
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Caron P, Turcotte V, Guillemette C. A quantitative analysis of total and free 11-oxygenated androgens and its application to human serum and plasma specimens using liquid-chromatography tandem mass spectrometry. J Chromatogr A 2021; 1650:462228. [PMID: 34090133 DOI: 10.1016/j.chroma.2021.462228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/13/2021] [Accepted: 04/30/2021] [Indexed: 01/16/2023]
Abstract
Bioactive 11-oxygenated C19 adrenal-derived steroids (11-oxy C19) are potentially relevant in diverse endocrine and metabolic contexts. We report the development and validation of a liquid chromatography electrospray ionization tandem mass spectrometric method (LC-ESI-MS/MS) for the simultaneous quantification of seven 11-oxy C19 using 200 µL of plasma or serum. Sample preparation involved chemical derivatization using hydroxylamine after liquid-liquid extraction to improve specificity and sensitivity. The method allowed the quantitation of total 11-oxy C19 (free + sulfate and glucuronide conjugates) following enzymatic hydrolysis. This included the abundant precursor 11-hydroxyandrostenedione (11OHA4) and the most potent androgenic derivatives 11-keto-testosterone (11KT) and 11-keto-dihydrotestosterone (11KDHT), their abundant metabolites 11-hydroxyandrosterone (11OHAST) and 11-keto-androsterone (11KAST) potentially feeding back into the pool of potent androgens, in addition to 11-keto-androstenedione (11KA4) and 11-hydroxytestosterone (11OHT). Stable isotopes were used as internal standards, and calibrators and quality controls were prepared in the same matrix as the study samples. Performance was validated against the Food and Drug Administration Criteria. The method was sensitive with lower limit of quantification (LLOQ) values of 10 and 20 pg/mL for free and total 11-oxy C19, respectively. The applicability was demonstrated in men and women adult donors that showed sex-differences. All steroids were quantified well above LLOQ, except 11KDHT that remained undetectable suggesting interfering endogenous molecules present in non-derivatized samples in which a peak was observed. By providing accurate and reliable quantitative data, this method will permit to evaluate how profiling of 11-oxy C19 will be most informative as diagnostic, prognostic and/or theranostic tools.
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Affiliation(s)
- Patrick Caron
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval Research Center and Faculty of Pharmacy, Laval University, Québec city, QC, Canada
| | - Véronique Turcotte
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval Research Center and Faculty of Pharmacy, Laval University, Québec city, QC, Canada
| | - Chantal Guillemette
- Pharmacogenomics Laboratory, Centre Hospitalier Universitaire (CHU) de Québec - Université Laval Research Center and Faculty of Pharmacy, Laval University, Québec city, QC, Canada; Canada Research Chair in Pharmacogenomics, Canada.
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