Gas chromatographic and gas chromatographic—mass spectrometric analysis of organic acids in plasma of patients with chronic renal failure

Mussel oil is superior to fish oil in preventing atherosclerosis of ApoE-/- mice

Objectives

The present study aimed to explore the preventive effect of mussel oil (MO) on atherosclerosis and the potential mechanism in apolipoprotein E-null (ApoE-/-) mice.

Methods

ApoE-/- mice were fed with a high-fat and high-cholesterol chow and given corn oil (CO), fish oil (FO), MO, or aspirin (ASP, dissolved in CO) by gavage for 12  weeks. The total n-3 polyunsaturated fatty acids (PUFAs) in MO (51.01%) and FO (46.82%) were comparable (mainly C22:6n-3 and C20:5n-3). Wild-type mice were fed with a normal chow and given equivalent CO as health control (CON).

Results

Compared with the CON group, obvious atherosclerotic plaque appeared at aorta and aortic sinus in the CO group. Compared with the CO group, MO but not FO had a significantly smaller atherosclerotic plaque area in the aorta. The aortic atherosclerotic plaque area was comparable in the MO, CON, and ASP groups. The MO group had a significantly smaller atherosclerotic plaque area, lower lipid deposition, lower contents of smooth muscle cell (SMC), and slightly lower contents of macrophage at the aortic sinus than the FO group. Serum concentrations of IL-1β, NF-κB, and VCAM-1 were comparable in the MO and FO groups and were significantly lower than the CO group. Compared with the CO group, the MO group but not FO group had significantly lower aortic protein levels of p65NF-κB, p38MAPK, and VCAM-1. The aortic protein levels of p-p65NF-κB and p-p38MAPK were significantly lower in the MO group than the FO group.

Conclusion

In conclusion, MO is more potent than FO in preventing atherosclerosis, and the possible mechanism may be by downregulating p38MAPK/NF-κB signaling pathway, decreasing VCAM-1 and macrophage, and inhibiting proliferation and migration of SMC.

Furan fatty acid metabolite CMPF is associated with lower risk of type 2 diabetes, but not chronic kidney disease: a longitudinal population-based cohort study

BACKGROUND

Furan fatty acid metabolite 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF) is a strong biomarker of fish and n-3 polyunsaturated fatty acid (PUFA) intake. The relationship of CMPF with human health has been controversial, especially for type 2 diabetes and chronic kidney disease.

OBJECTIVE

We performed a prospective cohort study to examine the association of serum CMPF with incident type 2 diabetes and chronic kidney disease.

METHODS

In the Guangzhou Nutrition and Health Study, during a median follow-up of 8.8 y, we used a multivariable-adjusted Poisson regression model to investigate the association of baseline serum CMPF with the incidence of type 2 diabetes (1470 participants and 170 incident cases) and chronic kidney disease (1436 participants and 112 incident cases). We also examined the association of serial measures of serum CMPF with glycemic and renal function biomarkers. Mediation analysis was also performed to examine the contribution of CMPF in the association between marine n-3 PUFAs and risk of type 2 diabetes or chronic kidney disease.

RESULTS

Each standard deviation increase in baseline serum CMPF was associated with an 18% lower risk of type 2 diabetes (relative risk: 0.82, 95% confidence interval [CI]: 0.68, 0.99) but was not associated with chronic kidney disease (relative risk: 0.95; 95% CI: 0.77-1.16). Correlation analyses of CMPF with glycemic and renal function biomarkers showed similar results. Mediation analysis suggested that serum CMPF contributed to the inverse association between erythrocyte marine n-3 PUFAs and incident type 2 diabetes (proportion mediated 37%, P-mediation = 0.022).

CONCLUSIONS

Our findings suggest that serum CMPF was associated with a lower risk of type 2 diabetes but not chronic kidney disease. This study also suggests that CMPF may be a functional metabolite underlying the protective relationship between marine n-3 PUFA intake and type 2 diabetes.

Total Synthesis of the Tetrasubstituted Furan Fatty Acid Metabolite CeDFP via Au-Catalyzed Intermolecular Alkyne Hydroarylation

The first total synthesis of the tetrasubstituted furan fatty acid (FFA) metabolite 5-[(1 E)-2-carboxyethenyl]-3,4-dimethyl-2-furanpentanoic acid (CeDFP) is reported. CeDFP is a FFA metabolite isolated from shark livers and is related to the known FFA metabolites CMPF and CMPentylF. Key elements of the synthetic route to CeDFP include an iodine-promoted 5- endo- dig cyclization of a 1,2-alkyne diol, a methyllithium-mediated insertion of the C₃-methyl group, and a Au(I)-catalyzed intermolecular hydroarylation to introduce the unsaturated ester.

Quantification of phenolic acid metabolites in humans by LC-MS: a structural and targeted metabolomics approach

AIM

Co-metabolism between a human host and the gastrointestinal microbiota generates many small phenolic molecules such as 3-hydroxy-3-(3-hydroxyphenyl)propanoic acid (3,3-HPHPA), which are reported to be elevated in schizophrenia and autism. Characterization of these chemicals, however, has been limited by analytic challenges.

METHODOLOGY/RESULTS

We applied HPLC to separate and quantify over 50 analytes, including multiple structural isomers of 3,3-HPHPA in human cerebrospinal fluid, serum and urine. Confirmation of identity was provided by NMR, by MS and other detection methods. The highly selective methods support rapid quantification of multiple metabolites and exhibit superior chromatographic behavior.

CONCLUSION

An improved ultra-HPLC-MS/MS and structural approaches can accurately quantify 3,3-HPHPA and related analytes in human biological matrices.

Furan fatty acids - Beneficial or harmful to health?

Furan fatty acids are found in plants, algae, and fish, and reported to have some positive health benefits, including anti-oxidant and anti-inflammatory activities, and inhibition of non-enzymatic lipid peroxidation. A major metabolite of furan fatty acids, 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), has been reported to be increased in patients who progress from prediabetes to type 2 diabetes, although CMPF is not necessarily associated with impaired glucose metabolism. Other studies report that CMPF levels are lower in subjects with diabetes than control subjects. Plasma CMPF levels increase in subjects who consume fish or fish oil, and in patients with renal failure. It is not known where furan fatty acids are converted to CMPF and it is speculated that this might be a result of microbiome activity. The plasma levels reported for CMPF in healthy, diabetic and patients with renal disease vary by factors of more than 100-fold within each of these three groups, so measurement error appears to be limiting the ability to interpret studies. This review explores these controversies and raises questions about whether CMPF is a marker for healthy diets or indeed associated with diabetes and renal health. The review concludes that, on balance, furan fatty acids are beneficial for health.

Furan fatty acids: occurrence, synthesis, and reactions. Are furan fatty acids responsible for the cardioprotective effects of a fish diet?

Furan FA (F-acids) are tri- or tetrasubstituted furan derivatives characterized by either a propyl or pentyl side chain in one of the alpha-positions; the other is substituted by a straight long-chain saturated acid with a carboxylic group at its end. F-acids are generated in large amounts in algae, but they are also produced by plants and microorganisms. Fish and other marine organisms as well as mammals consume F-acids in their food and incorporate them into phospholipids and cholesterol esters. F-acids are catabolized to dibasic urofuran acids, which are excreted in the urine. The biogenetic precursor of the most abundant F-acid, F6, is linoleic acid. Methyl groups in the beta-position are derived from adenosylmethionine. Owing to the different alkyl substituents, synthesis of F-acids requires multistep reactions. F-acids react readily with peroxyl radicals to generate dioxoenes. The radical-scavenging ability of F-acids may contribute to the protective properties of fish and fish oil diets against mortality from heart disease.

Monitoring haemodialysis using electronic nose and chemometrics

An ever-increasing number of patients have to undergo regular renal dialysis to compensate for acute or chronic renal failure. The adequacy of the treatment has a profound effect on patients' morbidity and mortality. Therefore, it is necessary to assess the delivered dialysis dose. For the quantification of the dialysis dose, two parameters are most commonly used, namely the K(t)/V value (normalised dose of dialysis) and the urea reduction rate, yet the prescribed dialysis dose often differs from the actual delivered dialysis dose. Currently, no interactive process is available to ensure optimal treatment. The aim of this study was to investigate the potential for an "electronic nose" as a novel monitoring tool for haemodialysis. Blood samples were analysed using an electronic nose, comprising an array of 14 conducting polymer sensors, and compared to traditional biochemistry. Principal component analysis and hierarchical cluster analysis were applied to evaluate the data, and demonstrated the ability to distinguish between pre-dialysis blood from post-dialysis blood independent of the method used. It is concluded that the electronic nose is capable of discriminating pre-dialysis from post-dialysis blood and hence, together with an appropriate classification model, suitable for on-line monitoring.

Protein-bound uremic retention solutes

Protein-bound uremic retention solutes are molecules with low molecular weight (MW) but should be considered middle or high MW substances. This article describes the best known substances of this group, which include p-cresol, indoxyl sulfate, hippuric acid, 3-carboxy-4-methyl-5-propyl-2-furan-propionic acid (CMPF), and homocysteine. At concentrations encountered during uremia, p-cresol inhibits phagocyte function and decreases leukocyte adhesion to cytokine-stimulated endothelial cells. CMPF has been implicated in anemia and neurologic abnormalities of uremia. CMPF could alter the metabolism of drugs of inhibiting their binding to albumin and their tubular excretion. Indoxyl sulfate administrated to uremic rats increases the rate of progression of renal failure. Hippuric acid inhibits glucose utilization in the muscle, and its serum concentration is correlated with neurologic symptoms of uremia. Homocysteine predisposes uremic patients to cardiovascular disease through impairment of endothelial and smooth muscle cell functions. The removal of protein-bound compounds by conventional hemodialysis is low. Other strategies to decrease their concentrations include increase in dialyze pore size, daily hemodialysis, peritoneal dialysis, reduction of production or acceleration of degradation, and preservation of residual renal function.

Production of antiserum for sensitive enzyme-linked immunosorbent assay of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid by chemiluminescence

To obtain a specific antiserum for use in enzyme-linked immunosorbent assay (ELISA) of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), we prepared a hapten-carrier conjugate in which the CMPF hapten was linked to a carrier protein through the 5-(1-hydrazopropyl) group. The antisera raised against this antigen in guinea pigs had excellent specificity for CMPF, showing little cross-reactivity with closely related compounds and no significant cross-reactivities with other furan compounds. The results indicated that a specific antiserum to CMPF could be produced by an antigen whose CMPF moiety is linked to a carrier protein through a position remote from the inherent functional groups. A standard curve of CMPF by ELISA using a chemiluminescence system showed a high sensitivity and a linearity in the range of 5-100 ng/mL.

Effects of uremic toxins and fatty acids on serum protein binding of furosemide: possible mechanism of the binding defect in uremia

To elucidate the mechanism of impaired serum binding of furosemide observed in patients with renal dysfunction, we examined in vitro the serum protein binding of furosemide in the absence and presence of uremic toxins that are endogenously retained solutes in uremic serum and act as inhibitors of drug binding. Analysis of the binding data of furosemide at its therapeutic concentration (6.6 mg/L) indicated that, among the four uremic toxins studied, 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF) showed the greatest inhibitory potency for the binding of furosemide to serum; moreover, the inhibition was competitive. CMPF thus most likely represents the primary determinant for the serum binding defect of furosemide in uremia. However, CMPF and oleate appear to exert a synergistic effect on the inhibition of furosemide serum binding—perhaps through a cascade effect on furosemide-binding inhibition in the oleate–CMPF–furosemide system, in which the binding of oleate to its low-affinity sites indirectly displaces furosemide from albumin and thus increases the transiently liberated CMPF molecules. Similar cascade effects on furosemide binding in the presence of CMPF were also originated by other long-chain (C18) fatty acids, linoleate and stearate, although to a lesser extent. Because CMPF is not effectively removed by ordinary hemodialysis treatment, the combined direct and cascade effects of CMPF and fatty acids appear to contribute to the increase in the free fraction of furosemide during hemodialysis.

Mass spectrometry in the search for uremic toxins

This article reviews the literature on the mass spectrometry (MS) that has been used in the research of uremic toxins. Gas chromatography/mass spectrometry (GC/MS) has been most often used for the analysis of low-molecular-weight compounds in uremic blood such as organic acids, phenols, and polyols. However, it cannot be used for the analysis of middle- to high-molecular-weight substances or for involatile compounds. The development of fast atom bombardment (FAB) and liquid secondary ion mass spectrometry (LSIMS) has made possible the analysis of middle-molecules and involatile low-molecular-weight substances such as peptides and nucleosides. The development of atmospheric pressure chemical ionization (APCI) has also lead to the analysis of involatile low-molecular-weight substances. The recent advances in ionization methods, such as electrospray ionization (ESI) and matrix-assisted laser desorption ionization (MALDI), have permitted the MS analysis of high-molecular-weight substances such as beta 2-microglobulin, a major component of dialysis amyloid. Liquid chromatography/mass spectrometry (LC/MS), using ESI, APCI, or FAB as an ionization method, is currently the preferred method for the analysis of low- to high-molecular-weight substances in uremic blood. ESI-LC/MS and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOFMS) are useful for elucidating the structure of post-translationally modified proteins obtained from the blood and tissues of uremic patients. Post-translational modification such as the formation of advanced glycation end-products and carbamoylation is enhanced in uremic patients, and is considered to be responsible for some uremic symptoms. Laser microprobe MS is unique in its capability for the two-dimensional detection of atoms such as aluminum in a tissue section obtained from uremic patients. This review focuses on the mainstream research for discovering uremic toxins, specific uremic toxins identified or quantified using MS, and the MS analysis of post-translationally modified proteins in uremia. These studies have provided ample evidence that MS has played an important role in the search for uremic toxins.

Synthesis and physicochemical properties of the furan dicarboxylic acid, 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid, an inhibitor of plasma protein binding in uraemia

The furan dicarboxylic acid, 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (5-propyl FPA) accumulates in the plasma of patients with chronic renal failure and is a major contributor to the drug binding defect of uraemic plasma. This acid has also been implicated in several other aspects of the uraemic syndrome: anaemia, irregularities of thyroid function, neurological symptoms and inhibition of active tubular secretion. The acid is not commercially available and its synthesis, starting with Meldrum's acid and methyl succinyl chloride, is described. The pKa values were measured by titration and values of 3.2 and 3.6 respectively were assigned to the carboxylic acid groups attached directly to the ring at position 3 and at position 2 (on the side-chain). The partition coefficient (log P) between hydrochloric acid and octanol was 1.2 and the distribution coefficient (log D; octanol-phosphate buffer pH 7.4) was -0.59. The pKa values and the degree of hydrophobic character of 5-propyl FPA are consistent with those of other protein-bound acids which undergo active tubular secretion by the kidney and this substance may serve as an endogenous marker for the effects of drugs and disease on this process.

Capillary electrophoresis as a clinical tool. Determination of organic anions in normal and uremic serum using photodiode-array detection

We report the use of free solution capillary electrophoresis to identify and quantify low-molecular-mass compounds found in normal and uremic serum as well as in hemodialysate fluid. The method reported provides a multicomponent analysis, allowing a single-step screening for more than 19 metabolites in less than 16 min. Serum samples from healthy individuals and from patients who have been diagnosed with chronic renal failure are analyzed using a borate buffer system at pH 9.0, and an extended light path capillary. Several ionic sample constituents are identified by electrophoretic mobility, UV spectra, and spiking with authentic standards. An analysis of the relative concentration of several metabolites, including hypoxanthine, pseudouridine, hippuric acid, and uric acid is presented. Each of these four metabolites is found in both normal and uremic serum samples (limits of detection 1 to 6 microM). Moreover, each of these metabolites is present at significantly elevated levels in uremic patients. The method reported is shown to have promising clinical utility for profiling serum sample constituents, and for quantitative determination of a few important metabolites.

Synthesis and preclinical evaluation of technetium-99m-labeled hippurate analogues

We have synthesized seven 99mTc-labeled hippurate analogues: 99mTc-hippurate. 99mTc-alpha-hydroxyhippurate, 99mTc-m-hydroxyhippurate. 99mTc-o-hydroxyhippurate [99m-salicylglycine (99mTc-SG)], 99mTc-p-hydroxyhippurate, 99mTc-salicylglycylglycine and 99mTc-salicylglycylglycylglycine. All of the 99mTc-hippurates were cleared rapidly from the rat blood and accumulated in the kidney. Of them 99mTc-SG has the desirable biological properties of two diagnostic agents. 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) and 99mTc-dimercaptosuccinate (99mTc-DMSA). A fraction of 99mTc-SG showed a transit time in the kidney and was excreted rapidly into the urine, being similar to 99mTc-MAG3. The binding ratio to the plasma proteins was 96.0% (91.1% in the albumin), being higher than that of 99mTc-DMSA, at 30 min. The lipophilicity revealed far less pH-dependent changes in a range of pH 4.0 to 7.4. 99mTc-SG distributed about 91% in the renal cortex, being similar to that of 99mTc-DMSA. From the present studies, the biological properties of 99mTc-SG suggest that it is a promising agent for measuring renal plasma flow and renal morphology.

Structural analysis of oxidation products of urofuran acid by hypochlorous acid

The oxidation of urofuran acid derivatives (1-2) by hypochlorous acid (HOCl) was investigated with the goal to possibly simplify the detection of their metabolites in biological materials. The oxidation products of 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (1) were obtained as an isomeric mixture and confirmed to exist as cis (3a) and trans (3b) isomers, based on their 13C nuclear magnetic resonance (NMR) spectra. Similarly, the products of 5-H substituted acid 2 obtained by oxidation with HOCl were identified as 4a and 4b by 13C and 1H NMR which indicated the presence of cis and trans hemiacetal hydrogens at C-5 in a ratio of 2.11:1. The oxidation was found to proceed in a manner different from that of the F-acid, because of the presence of the electron withdrawing COOCH3 group at C-3 which favored the nucleophilic attack on the carbonyl group to afford cis- and trans-2,5-dihydroxy-2,5-dihydrofurans (3a-b, 4a-b).

Albumin binding in uraemia: quantitative assessment of inhibition by endogenous ligands and carbamylation of albumin

The binding capacity of human serum albumin (HSA) for small acidic molecules is known to be reduced in chronic renal failure (CRF). The contribution of competitive inhibition by accumulated endogenous ligands and of structural changes in HSA has now been evaluated. In a fluorimetric in vitro assay using HSA and two dansylated amino acids the inhibitory properties of various endogenous ligands were determined in concentration-effect studies. The effect of carbamylation of HSA on binding was also examined. The mode of inhibition, including binding parameters n and Ka, was determined. Finally, HSA binding in sera from controls and dialysis patients was compared in a modified assay. Thirty three substances were tested and were placed in 3 groups: strong inhibitors (IC50 < 3*10(-5) mol.l-1, e.g. indolyl acids, furanoic acids), medium inhibitors (IC50 > 3*10(-5), eg. vanillic acid), and no inhibition (e.g. urea, creatinine, guanidino compounds). Complete (> 80%) carbamylation of HSA reduced binding by 67% in a non-competitive mode. There was a significant reduction in the binding capacity of HSA from the dialysis patients (approximately 24%), irrespective of medication. It is concluded that the uraemic binding defect of HSA is caused by competitive inhibition by the many physiological ligands accumulated in CRF and structural modifications of HSA. The assay presented proved useful for the rapid analysis of possible HSA binding inhibitors and for testing large groups of patients, e.g. comparison of dialysis treatments, and pharmacological binding studies.

Interaction of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid, an inhibitor of plasma protein binding in uraemia, with human albumin

The furan dicarboxylic acid 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (5-propyl FPA) accumulates in uraemic plasma and is a potent inhibitor of the binding of other anionic ligands to albumin. The interaction of 5-propyl FPA with human albumin has been investigated by equilibrium dialysis at 37 degrees and pH 7.4. Analysis of the binding data on the basis of a two-site model gave binding parameters of n1 = 0.6 and K1 = 4.8 x 10(6) M-1 for the primary binding site. 5-Propyl FPA binding was observed to decrease as the pH was raised from 6.4 to 8.3 which emphasizes the need for pH control of whole plasma or serum. Temperature, however, had little effect on binding as assessed by equilibrium dialysis at 10 degrees, 25 degrees and 37 degrees. The high affinity of 5-propyl FPA for albumin explains its retention in uraemic plasma, its potency as a binding inhibitor and points to active tubular secretion as the mechanism by which it is normally excreted by the kidney.

Analysis of plasma hippurate in humans using gas chromatography-mass spectrometry: concentration and incorporation of infused [15N]glycine

To allow in vivo determination of synthetic rates for individual proteins, physiological incorporation of infused [15N]glycine into urinary hippuric acid has been used as an indicator of intrahepatic tracer dilution. Although the kidneys might contribute to hippurate production, the relationship between hepatic, plasma, and urinary hippurate has not yet been established in humans. To further investigate these issues we developed a fast, sensitive, and reliable method for measuring simultaneously hippurate concentrations and in vivo tracer incorporation into hippurate in plasma and urine using stable isotopes and gas chromatography-mass spectrometry. We then tested this assay under several experimental conditions. Reference compounds [( 15N]- and [ring-2H5]hippurate) were synthesized and gave linear standard curves. Postabsorptive hippurate plasma levels in healthy subjects ranged from 1.2 to 10.5 microM and protein binding was 79 +/- 6% (mean +/- SD). Following a bolus dose of [15N]glycine tracer appeared in plasma hippurate; enrichment in hippurate was indistinguishable from that in glycine after an equilibration period of 20 min, indicating a close relationship between intracellular glycine and plasma hippurate. A 16-h infusion of [15N]glycine resulted in identical enrichment levels in urinary and plasma hippurate; glycine enrichment in a hepatic export protein (VLDL-ApoB) was approaching plasma hippurate but not plasma free glycine enrichment. The ability to monitor plasma hippurate is of practical advantage compared to the sampling of urine. Furthermore it allows the monitoring of rapid events in the intrahepatic dilution of an infused glycine tracer. This assay may, therefore, become an important tool in the study of hepatic protein metabolism.

Hippuric acid and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid in serum and urine. Analytical approaches and clinical relevance in kidney diseases

Hippuric acid (HA) and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (FA) were determined in serum, plasma, ultrafiltrate and urine by gas chromatography (GC), high-performance liquid chromatography and GC with mass-selective detection, and the methods were compared. As determined by affinity chromatography and analysis of serum and ultrafiltrate, 0.5% of FA in serum occurs free and 99.5% is bound to albumin. In haemodialysed patients with chronic renal failure, the plasma levels of HA and FA are elevated in comparison with normal controls and hospital patients without kidney diseases: HA, 11.1 +/- 5.7 mg/dl (n = 86); FA, 1.9 +/- 1.2 mg/dl (n = 86). Gradual increases in HA in serum, depending on the creatinine concentrations, are found in non-dialysed patients with chronic renal failure. By haemodialysis and haemofiltration the HA levels are lowered (53-66 and 30-36%, respectively), whereas FA is not dialysable.

Basic profiles of organic acids in urine

Altogether 143 of the organic acids regularly occurring in urine of healthy individuals are identified as methyl esters by gas chromatography-mass spectrometry with respect to their complete chemical structures. They are classified as dicarboxylic acids, oxocarboxylic acids, hydroxycarboxylic acids, aromatic acids, furancarboxylic acids, nitrogen-containing acids and acid conjugates. By pre-fractionating the complex mixture of the total organic acids, peak overlap is minimized, and substances in low concentrations can also be detected and identified. The qualitative patterns of the urinary organic acids in the fractions are constant and reproducible, and in many cases a reliable identification of organic acids is possible by gas chromatography alone, using methylene units and separation on OV-1701 capillary columns.

Determination of hippuric acid and furanic acid in serum of dialysis patients and control persons by high-performance liquid chromatography

A high-performance liquid chromatographic method for the determination of 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (furanic acid) and hippuric acid in human serum is described. Quantitative data were obtained from 20 blood donors, 26 non-dialysis patients and 41 dialysis patients. In healthy persons hippuric acid ranged from 0.2 to 0.6 mg/dl, furanic acid from 0.13 to 0.53 mg/dl. In dialysis patients the mean concentration of hippuric acid was elevated to 17.2 mg/dl (range 1.7-50.8 mg/dl) and the mean concentration of furanic acid was elevated to 1.89 mg/dl (range 0.17-6.45 mg/dl). In patients without renal insufficiency the concentrations were not elevated. These data are in accordance with previous data obtained by gas chromatographic methods. Preliminary results indicate that hippuric acid and furanic acid may be more specific parameters than other uremic retention products, and better indicators for the need for dialysis treatment than urea or creatinine.

Accumulation of furancarboxylic acids in uremic serum as inhibitors of drug binding

3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, 3-carboxy-4-methyl-5-pentyl-2-furanpropionic acid, 3-carboxy-4-methyl-5-ethyl-2-furanpropionic acid and 3-carboxy-5-propyl-2-furanpropionic acid were detected in uremic serum using gas chromatography-mass spectrometry. Mass chromatography revealed that the serum concentrations of the furancarboxylic acids especially 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, were increased in the chronic hemodialysis patients and that the acids could not be removed by conventional hemodialysis due to their strong binding to plasma protein. 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid was also quantitated in uremic serum by high-performance liquid chromatography. Serum level of the acid in uremic patients showed significant but weak correlation with serum level of urea and duration on hemodialysis. Equilibrium dialysis demonstrated that 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid and 3-carboxy-4-methyl-5-pentyl-2-furanpropionic acid inhibited the bindingof salicylate and 5,5-diphenylhydantoin to albumin. In conclusion, the furancarboxylic acids especially 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid were accumulated in uremic serum as inhibitors of drug binding.

Simultaneous determination of C2-C22 non-esterified fatty acids and other metabolically relevant carboxylic acids in biological material by gas chromatography of their benzyl esters

A method for the simultaneous determination of non-esterified short-, medium- and long-chain fatty acids and other types of metabolically relevant carboxylic acids such as hydroxy, keto, aromatic and dicarboxylic acids in biological material by capillary gas chromatography of benzyl ester derivatives is described. Sample preparation avoiding incomplete isolation of carboxylic acids consisted of deproteinization and extraction with ethanol, fixation of carboxylic acids as carboxylates, removal of interfering compounds such as neutral lipids by hexane extraction and amino acids, acyl carnitines and other cations by cation-exchange chromatography, derivatization of keto groups of ketocarboxylic acids into O-methyl oximes and benzyl ester formation by reaction of the potassium carboxylates with benzyl bromide via crown ether catalysis. The sample preparation conditions were investigated, showing the usefulness of this method for quantitative determinations. Chromatograms obtained from human serum, human urine and rat heart ventricle and concentrations of carboxylic acids in these specimens are presented.

Contributions of hippurate, indoxyl sulfate, and o-hydroxyhippurate to impaired ligand binding by plasma in azotemic humans

We have evaluated pH, chloride, calcium and several endogenous aromatic acids as possible causes of the impaired binding of drugs by plasma albumin in renal failure. Changes in pH, chloride and calcium over the range found in renal failure had minimal or no effects on the binding of [14C]salicylate, a model probe which binds to both of the major drug-binding loci of human albumin. Hippurate and indoxyl sulfate were weak inhibitors of binding by normal plasma. Ortho-hydroxy-hippurate was undetectable or minimally elevated, except among patients with elevated plasma salicylate concentration. Although plasma hippurate and indoxyl sulfate concentrations were elevated markedly in patients with renal failure, inhibition of salicylate binding was significantly correlated only with the concentration of indoxyl sulfate. Addition of hippurate and indoxyl sulfate separately and together to normal plasma showed that these ligands could account for only 15% of the impaired binding of salicylate by azotemic plasma. The retained solutes which account for most of this binding defect remain to be identified. This uremic disorder (and perhaps others) is due not to a single chemical but to the additive effect of a family of chemicals.

Metabolic profiling with gas chromatography-mass spectrometry and its application to clinical medicine

Nowadays, metabolic profiling is widely applied in clinical medicine for the diagnosis and study of human diseases. The number of these applications and their diversity have increased rapidly in the past few years. This review summarizes recent advances in the methods for sample pretreatment and the clinical application of GC-MS to the study of uraemia, diabetes mellitus, dicarboxylic aciduria and other organic acidurias. High-resolution GC-MS is well suited to the profile analysis of metabolic disorders.

Gas chromatographic profiling of ketone bodies and organic acids in diabetes

Diabetes mellitus is a defect not only in glucose metabolism, but also in the metabolism of lipids and amino acids. Gas chromatographic and gas chromatographic--mass spectrometric profile analyses have contributed much to the understanding of the metabolic changes connected with this defect. Ketones are isolated by a gas-phase extraction and adsorption technique and profiled after thermal desorption. Organic acids are isolated by solvent extraction or anion exchange, derivatized and separated either as total acid profiles or subprofiles after pre-fractionation of the acid derivatives. The main results are as follows. (a) Increased total 4-heptanone is inherently connected with diabetes mellitus. Its urinary levels are elevated in therapeutically well controlled patients. (b) A general ketogenesis pathway leads to higher molecular weight ketone bodies in addition to the conventional ketone bodies. (c) During diabetic ketoacidosis, in addition to the fatty acids the following acids are elevated in serum and in urine: dicarboxylic acids resulting from omega- and beta-oxidation of monocarboxylic acids; oxomonocarboxylic acids as metabolites of the amino acids valine, leucine and isoleucine and as products of ketogenesis; and hydroxymonocarboxylic acids, also originating from amino acids and from ketogenesis.