High plasma level of a eumelanin precursor, 6-hydroxy-5-methoxyindole-2-carboxylic acid as a prognostic marker for malignant melanoma

A method for measuring serum levels of melanin-associated indole metabolites using LC-MS/MS and its application to malignant melanoma

BACKGROUND AND AIMS

With the development of novel therapies for advanced malignant melanoma (MM), biomarkers that can accurately reflect the progression of MM are needed. Serum levels of melanin-related indole metabolites such as 5-hydroxy-6-methoxyindole-2-carboxylic acid (5H6MI2C) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) are potential biomarkers for MM. Here, we describe the development of a mass spectrometry (MS)-based assay to determine serum levels of 5H6MI2C and 6H5MI2C.

MATERIALS AND METHODS

We developed a stable isotope dilution-selective reaction monitoring-MS protocol using liquid chromatography tandem mass spectrometry (LC-MS/MS) to measure human serum 5H6MI2C and 6H5MI2C levels. Analytical evaluations of the method were performed and the method was applied to serum samples from MM patients (n = 81).

RESULTS

The method established in this study showed high reproducibility and linearity. This novel method also found that serum 6H5MI2C levels were significantly elevated in patients with metastatic MM compared to those with non-metastatic MM. Unfortunately, 5H6MI2C did not show a comparable significant difference.

CONCLUSION

We successfully established measurement methods for serum 5H6MI2C and 6H5MI2C levels using LC-MS/MS. Serum 6H5MI2C levels offer a potential marker for MM.

Combination of serum 5-S-cysteinyldopa, melanoma inhibitory activity and IL-8 improves the diagnostic accuracy of malignant melanoma compared with individual markers

Early diagnosis of malignant melanoma is critical for effective treatment and reduced patient mortality. However, current clinical and histological variables show limited accuracy in diagnosis. Serum or urine level of 5-S-cysteinyldopa (5-S-CD) is a commonly used melanoma biomarker in Japan owing to its increased sensitivity compared with other melanoma markers. However, its use as a diagnostic marker has shown some limitations. Therefore, here we examined the combination of 5-S-CD with melanoma inhibitory activity, which showed sensitivity in detecting melanoma comparable with that of 5-S-CD, and interleukin-8, a cytokine linked with melanoma progression, in a cohort of Japanese patients with melanoma. Our results revealed that the triple combination of 5-S-CD, melanoma inhibitory activity, and interleukin-8 showed high diagnostic accuracy in detecting melanoma compared with each of the individual factors. Importantly, the triple marker showed specificity and utility in detecting early-stage melanoma. Our results suggest the utility of the triple marker as a diagnostic biomarker for melanoma patients.

Strong Dependence between Tryptophan-Related Fluorescence of Urine and Malignant Melanoma

Urine autofluorescence at 295 nm is significantly higher in patients with malignant melanoma at each clinical stage compared to the healthy group. The largest difference is in the early-stages and without metastases. With increasing stage, the autofluorescence at 295 nm decreases. There is also a significant negative correlation between autofluorescence and Clark classification. Based on our results, it is assumed that the way malignant melanoma grows also affects urinary autofluorescence.

Multiple tyrosine metabolites are GPR35 agonists

Both kynurenic acid and 2-acyl lysophosphatidic acid have been postulated to be the endogenous agonists of GPR35. However, controversy remains whether alternative endogenous agonists exist. The molecular targets accounted for many nongenomic actions of thyroid hormones are mostly unknown. Here we report the agonist activity of multiple tyrosine metabolites at the GPR35. Tyrosine metabolism intermediates that contain carboxylic acid and/or catechol functional groups were first selected. Whole cell dynamic mass redistribution (DMR) assays enabled by label-free optical biosensor were then used to characterize their agonist activity in native HT-29. Molecular assays including β-arrestin translocation, ERK phosphorylation and receptor internalization confirmed that GPR35 functions as a receptor for 5,6-dihydroxyindole-2-carboxylic acid, 3,3',5'-triiodothyronine, 3,3',5-triiodothyronine, gentisate, rosmarinate, and 3-nitrotyrosine. These results suggest that multiple tyrosine metabolites are alternative endogenous ligands of GPR35, and GPR35 may represent a druggable target for treating certain diseases associated with abnormality of tyrosine metabolism.

Pump-probe imaging differentiates melanoma from melanocytic nevi

Melanoma diagnosis is clinically challenging: the accuracy of visual inspection by dermatologists is highly variable and heavily weighted toward false positives. Even the current gold standard of biopsy results in varying diagnoses among pathologists. We have developed a multiphoton technique (based on pump-probe spectroscopy) that directly determines the microscopic distribution of eumelanin and pheomelanin in pigmented lesions of human skin. Our initial results showed a marked difference in the chemical variety of melanin between nonmalignant nevi and melanoma, as well as a number of substantial architectural differences. We examined slices from 42 pigmented lesions and found that melanomas had an increased eumelanin content compared to nonmalignant nevi. When used as a diagnostic criterion, the ratio of eumelanin to pheomelanin captured all investigated melanomas but excluded three-quarters of dysplastic nevi and all benign dermal nevi. Additional evaluation of architectural and cytological features revealed by multiphoton imaging, including the maturation of melanocytes, presence of pigmented melanocytes in the dermis, number and location of melanocytic nests, and confluency of pigmented cells in the epidermis, further increased specificity, allowing rejection of more than half of the remaining false-positive results. We then adapted this multiphoton imaging technique to hematoxylin and eosin (H&E)-stained slides. By adding melanin chemical contrast to H&E-stained slides, pathologists will gain complementary information to increase the ease and accuracy of melanoma diagnosis.

In vivo and ex vivo epi-mode pump-probe imaging of melanin and microvasculature

We performed epi-mode pump-probe imaging of melanin in excised human pigmented lesions and both hemoglobin and melanin in live xenograft mouse melanoma models to depths greater than 100 µm. Eumelanin and pheomelanin images, which have been previously demonstrated to differentiate melanoma from benign lesions, were acquired at the dermal-epidermal junction with cellular resolution and modest optical powers (down to 15 mW). We imaged dermal microvasculature with the same wavelengths, allowing simultaneous acquisition of melanin, hemoglobin and multiphoton autofluorescence images. Molecular pump-probe imaging of melanocytes, skin structure and microvessels allows comprehensive, non-invasive characterization of pigmented lesions.

Close monitoring and lifetime follow-up is optimal for patients with a history of melanoma

Malignant melanoma, a potentially lethal form of skin cancer, is becoming more common each year in the United States and worldwide. The cure rate, however, is also increasing due to better education, earlier detection, and more effective treatment. Thus, there are more melanoma survivors who are at risk for recurrence of melanoma and also a second primary. Because there are few prospective screening and surveillance results in the medical literature, recommendations for follow-up of melanoma survivors have been based on the natural history of the disease, physical examinations, laboratory tests, and radiologic evaluations.

Metastatic melanoma of the skin: Surgical treatment

<zakljucak> Bolesnici sa metastatskom diseminacijom bolesti imaju srednje prezivljavanje od oko 6 meseci. Bolesnici sa malim brojem metastatskih lezija i produzenim intervalom bez bolesti mogu imati korist od hirurske ekscizije. Ukoliko je izvodljiva, hirurgija udaljenih metastaza ima znacaja u palijativnom smislu radi redukcije simptomatologije koju njihova pojava daje kao i radi poboljsanja kvaliteta i produzavanja zivota. Samo se operacijom metastaza, ukoliko je to izvodljivo, moze znacajno produziti zivot bolesnika sa metastatskim melanomom. Oko 25% bolesnika u IV klinickom stadijumu mogu biti kandidati za operaciju, bilo samu ili u sklopu kombinovanog lecenja koje ukljucuje jos i sistemsku imuno, biohemijsku i radijacijsku terapiju. Napredak u imunoterapiji, biohemioterapiji i radioterapiji nije doneo znacajnije poboljsanje u lecenju bolesnika sa metastatskim melanomom. Hirursko je, za sada, jedino standardno lecenje ovih bolesnika, dok se svi ostali modaliteti terapije primenjuju kroz kontrolisane klinicke studije.

Clinical evaluation of 5-S-cysteinyldopa testing using a new and optimized detection system as a tumour marker for malignant melanoma

5-S-cysteinyldopa (5-S-CD) has been described as a tumour marker for the detection of human metastatic melanoma. We investigated the clinical utility of a new and optimized method to detect 5-S-CD by analysing 207 plasma samples derived from 138 patients with clinical stage I/II ( = 60), III ( = 32) or IV ( = 46) melanoma. Control groups consisted of 27 patients with non-melanoma skin diseases and 30 healthy volunteers. 5-S-CD plasma levels were determined using a new analytical technique based on a fully automated solid phase extraction coupled online to a novel high performance liquid chromatography method. In all the samples from the healthy control subjects 5-S-CD plasma concentrations were below 2.0 microg/l. Increased 5-S-CD-levels (>/=2.0 microg/l) were found in 52%, 67% and 81% of the plasma samples from patients with stages I/II, III and IV malignant melanoma, respectively. The mean values of 5-S-CD were found to rise with increasing tumour stage. Among 27 samples from patients with non-melanoma skin disease, slightly elevated 5-S-CD levels between 2.3 and 2.6 microg/l were found in only four samples from patients with multiple dysplastic naevi. In conclusion, our improved analytical technique provides a high sensitivity in all stages of the disease and represents a useful technique for monitoring melanoma patients.

Cysteine and indole derivatives as markers for malignant melanoma

Malignant melanoma is a skin tumour, which carries a very unfavourable prognosis. The early detection of a melanoma and even more its metastasis is of decisive importance for the survival prognosis of the patients. So there is always a desire for simple, economical and meaningful serological markers. From the cysteine- and indole-related derivatives, 5-S-cysteinyldopa (5-SCD) and 6-hydroxy-5-methoxy-indole-2-carboxylic acid (6H5MI2C) are the most important substances for this purpose. For 5-SCD, the sample pretreatment was carried out either by a manual extraction onto alumina, by an automated method onto boronic acid affinity gels or by an automated solid-phase extraction. For 6H5MI2C, liquid-liquid extractions or direct injection techniques were applied. The chromatographic analyses in the early years were mostly performed with GC-MS. Today HPLC is the nearly exclusively used separation technique. For HPLC, standard RP18 separating columns and usual compositions of eluents were applied. As detectors both the ECD and the FD showed a sufficient sensitivity and selectivity. 5-SCD and 6H5MI2C are very sensitive to light and oxidation. These properties must be taken into account in the complete analysis procedure, including the sample collection, otherwise false low values will result especially for plasma samples. For a critical discussion of the analytical methods and still more for the interpretation of the obtained results, the detailed analytical procedures must be considered. 5-SCD in plasma is one of the best markers of malignant melanoma. It shows an excellent specificity and also an adequate sensitivity in the metastatic melanoma stages. For the detection of primary melanomas and for urine instead of plasma samples, the sensitivity of 5-SCD is generally lower. Altogether, the sensitivity of this parameter is not yet sufficient. 6H5MI2C and other indole derivatives have been investigated far less than 5-SCD. 6H5MI2C correlates less clearly with the different stages of the melanoma and is therefore a less suitable marker. To improve the sensitivity of the findings, in future the investigations should be performed as multi-marker analysis with the simultaneous measurements of more than one marker substance in a given patient sample. Not only one measurement should be carried out per patient, it would be more meaningful to observe the patients with laboratory diagnostics in the follow-up.

Validation of denaturing high performance liquid chromatography as a rapid detection method for the identification of human INK4A gene mutations

The incidence of melanoma is increasing rapidly in western countries. Genetic predisposition in familial and in some sporadic melanomas has been associated with the presence of INK4A gene mutations. To better define the risk for developing sporadic melanoma based on genetic and environmental interactions, large groups of cases need to be studied. Mutational analysis of genes lacking hot spots for sequence variations is time consuming and expensive. In this study we present the application of denaturing high performance liquid chromatography (DHPLC) for screening of mutations. Exons 1alpha, 2, and 3 were amplified from 129 samples and 13 known mutants, yielding 347 products that were examined at different temperatures. Forty-two of these amplicons showed a distinct non-wild-type profile on the chromatogram. Independent sequencing analysis confirmed 16 different nucleotide variations in Leu32Pro; Ile49Thr; 88 del G; Gln50Arg; Arg24Pro; Met53Ile; Met53Thr; Arg58stop; Pro81Leu; Asp84Ala; Arg80stop; Gly101Trp; Val106Val; Ala148Thr; and in positions (-2) in intron 1 (C --> T); and in the 3' UTR, nucleotide 500 (C --> G). No false negatives or false positives were obtained by DHPLC in samples with mutations or polymorphisms. We conclude that the DHPLC is a fast, sensitive, cost-efficient, and reliable method for the scanning of INK4A somatic or germline mutations and polymorphisms of large number of samples.

Malignant melanoma

CONTEXT

The rapidly developing fields of melanoma research are revolutionizing the current concepts on melanoma etiology and pathogenesis and are introducing newer diagnostic techniques and potential therapeutic approaches.

OBJECTIVES

To present the most current concepts on the etiology and pathogenesis of melanoma and to introduce the recent diagnostic techniques and the potential therapeutic approaches.

METHODS

Data sources were reports on melanoma published in the English language literature and observations made using specimens available at Harvard University, Johns Hopkins Medical Center, Albany Medical College, Loyola University Medical Center, and University of Tennessee Health Science Center.

RESULTS

Studies on melanoma containing chromosomal or genetic evaluation were selected for further analysis. Current clinical and pathologic categories with the reported genetic abnormalities were related to the latest information on pigment biology. The data extracted were used to develop a conceptual framework on the pathogenesis of melanoma; the generated model was then evaluated and used to suggest potential therapeutic approaches.

CONCLUSIONS

(1) Melanoma is not genetically homogeneous, and the existing differences between the pathologic categories, particularly in areas such as type of growth phase (radial vs vertical growth), total vertical dimension, ulceration of primary tumor, and metastatic process, have profound prognostic and therapeutic implications. (2) Chromosomal aberrations and gene mutations are found in sporadic and familial melanomas; among the most important are those affecting the 9p21, which contains the p16 locus, a site known to be critical for normal progression of the cell cycle. Aberrant p16 expression is associated with more aggressive behavior. (3) Melanoma cells possess a remarkable repertoire of biosynthetic capacities represented by the production of hormones, growth factors, and their receptors that may sustain and accelerate tumor development and progression. For example, expression of the tumoral products alpha-melanocyte-stimulating hormone and adrenocorticotropic hormone is regulated in vitro by ultraviolet light, a known carcinogen. (4) Melanomas differ from other tumors in their intrinsic capability to express melanogenic enzymes with the corresponding structural proteins to actually synthesize melanin. Melanogenesis-related proteins are rapidly entering the clinical arena, being used not only as diagnostic markers, but also as potential targets for melanoma therapy.

The value of cysteinyldopa in the follow-up of disseminated malignant melanoma

In a series of 92 patients with malignant melanoma, clinical stage III or IV, both 5-S-cysteinyldopa (5SCD) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) were measured in urine during chemotherapy. A total of 434 urine specimens were analysed. The sensitivity of 5SCD for the detection of stage III-IV melanoma was 83%, while the corresponding sensitivity of 6H5MI2C was 52%. Fifty per cent of patients with one metastatic site had increased 5SCD excretion, while all patients with four or more metastatic sites had increased excretion. A significant correlation was found between 5SCD decrease and clinical regression (P<0.001) and between 5SCD increase and clinical progression (P<0.001). Corresponding correlations were not found for 6H5MI2C. Increments in 5SCD excretion (median 269 micromol/mol creatinine) were seen for 83% of the occasions when clinical progression was recorded, and decrements in 5SCD excretion (median 145 micromol/mol creatinine) were seen for 85% of the occasions when clinical regression was seen. During clinical 'stable disease' increases in 5SCD excretion were seen in 59% and decreases in 41%. The median value of 5SCD changes for stable disease was 7.0 micromol/mol creatinine, indicating a chemical marker stability in many cases. We recommend the use of 5SCD in urine as a valuable, reliable and simple biochemical marker to use in the clinical follow-up of melanoma patients with advanced disease.

Whole blood glutathione peroxidase activity in melanoma patients

We have studied whole blood glutathione peroxidase activity as a possible diagnostic factor or marker for detection and diagnosis of patients with melanoma. This activity was determined in 40 melanoma patients (MP) and in 40 healthy persons (HP) using an enzymatic method. We found a mean value of 17.90+/-6.82 units/ml in MP and 27.07+/-14.35 units/ml in HP. A very significant decrease in whole blood glutathione peroxidase activity was observed in MP in comparison to the enzymatic activity in HP (P = 0.0005). In order to check whether this test could discriminate between MP and HP, a complete statistical Receiver Operating Characteristic (ROC) curve analysis was performed. The cut-off value was 14.26 units/ml. The area under the curve was 0.737. According to these results, the test could discriminate adequately between both groups. However, the high specificity and low sensitivity values associated with that cut-off value would make this test a very valuable tool for confirming the detection, rather than for primary screening.

Determination of 5-S-cysteinyldopa in plasma and urine using a fully automated solid-phase extraction--high-performance liquid chromatographic method for an improvement of specificity and sensitivity of this prognostic marker of malignant melanoma

5-S-Cysteinyldopa (5-SCD) in plasma and urine was determined by means of a newly developed method. This method incorporates optimized conditions for blood collection and storage, as well as a new extraction and separation technique, required for the strong oxidation and light sensitive 5-SCD. The new aspects of the method are the following: immediate centrifugation and freezing of the samples after blood collection, fully automatical solid-phase extraction (SPE) with phenylboronic acid (PBA) cartridges and immediate HPLC injection of the eluate, nearly complete exclusion of light and air-oxygen during extraction, constant sample cooling, use of the more suitable internal standard 5-S-D-cysteinyldopa and easy, sensitive and selective HPLC conditions (RP18-column with isocratic separation and electrochemical detection). The method has a linear range from 0.25 to 50 microg l(-1) and 25 to 5000 microg l(-1) for plasma and urine samples, respectively, a limit of detection of 0.17 microg l(-1), intra-assay variabilities from 1.7 to 3.6%, inter-assay variabilities from 4.0 to 18.3% and an average relative recovery of 103.5% for plasma and 105.4% for urine samples. In our study the measured 5-SCD concentrations of patients with melanomas at various stages correlated better with their clinical pictures than described in literature up to date. The results were obtained in comparison to patients with other skin tumors and in comparison to healthy control persons.

Laboratory tests and imaging studies in patients with cutaneous malignant melanoma

Laboratory tests and imaging studies are often ordered for asymptomatic patients with malignant melanomas (MMs) in an effort to detect subclinical metastatic disease. However, their sensitivity and specificity for detecting cryptic metastases are not well established. A review of the literature on laboratory tests and imaging studies for MM metastases was undertaken to address the usefulness of such investigations in asymptomatic patients with MM in AJCC (American Joint Committee on Cancer system of classification) stages I, II, and III. A review of the pertinent literature since 1966 was conducted through MEDLINE, Medica, and Cancerlit. Laboratory tests and imaging studies revealed occult MM metastases in only a small number of the thousands of reported patients with putative AJCC stage I, II, and III MM. However, for those diagnosed with limited metastases, surgical removal with or without immunotherapy, chemotherapy, or radiotherapy can lead to long-term remissions in some patients. For patients with asymptomatic AJCC stage I or II disease, chest roentgenograms (CXR) and blood lactic dehydrogenase (LDH) levels may be obtained at low cost and prove to be of benefit if metastases are identified. For patients with AJCC stage III disease, computed tomographic (CT) scans of the thorax, abdomen, and pelvis (especially when the primary cutaneous site of the melanoma is below the waist) may be considered for detecting metastatic MM. Other tests, such as magnetic resonance imaging (MRI) scans of the brain, may be ordered based on symptoms or physical findings. In the future, technologically improved techniques and newer methods may prove cost-effective for detecting treatable asymptomatic MM metastases. Furthermore, improvement in treatments will also influence the indications for the search for occult MM metastases. At this time there is a need for an international consensus conference on laboratory tests and imaging studies for occult melanoma metastases.

Prognosis in malignant melanoma

A uniform and practical classification and staging system for melanoma must exist and be widely adopted if useful comparisons between different treatment centers and databases are to be made. This article reviews the 1992 American Joint Committee on Cancer pTNM staging system. In this classification, localized disease without regional nodal involvement is defined as stage I or II, depending on the tumor thickness of the primary melanoma. Regional lymph node involvement and/or in-transit metastasis is defined as stage III, and systemic metastatic disease is defined as stage IV.

Serum tyrosine hydroxylase activity is increased in melanoma patients. An ROC curve analysis

We have studied the serum tyrosine hydroxylase activity of tyrosinase, the key enzyme in the melanogenesis via, as a possible diagnostic factor or marker for detection, prognosis and follow-up of patients with melanoma. This activity was determined in 30 melanoma patients (MP) and in 30 healthy persons (HP) by using a radiometric method. We found mean values of 10.8+/-3.0 and 7.65+/-2.32 mU/l for serum tyrosine hydroxylase activity in MP and HP, respectively. A very significant increase in serum tyrosine hydroxylase activity was observed in MP in comparison to the enzymatic activity in HP (P < 0.00001). Although these data seem very conclusive, we wanted to know whether this test could discriminate adequately between MP and HP. In order to reach this aim, a complete statistical study was performed by using receiver operating characteristic (ROC) curve analysis. The cut-off value obtained was 8.47 mU/l. According to our results and after analytical treatment of the data, we can confirm that evaluation of tyrosine hydroxylase activity in serum could be a quick and reliable diagnostic method for detection, prognosis and follow-up in melanoma patients.

Determination of the L-DOPA/L-tyrosine ratio in human plasma by high-performance liquid chromatography. Usefulness as a marker in metastatic malignant melanoma

A first procedure was devised for determining 3,4-dihydroxyphenylalanine (L-DOPA) in human plasma by isocratic RP-HPLC coupled with electrochemical detection. A second procedure was devised for determining 3-hydroxyphenylalanine (L-tyrosine) in human plasma by isocratic RP-HPLC coupled with fluorescence detection. These methods were used to ascertain the L-DOPA/L-tyrosine ratio in plasma of patients with melanoma. Reference values were established by analysis of the L-DOPA/L-tyrosine ratio in the plasma of 35 normal healthy subjects. For 29 patients diagnosed as having melanoma without metastasis, the L-DOPA/L-tyrosine (11.96 x 10(-5) +/- 2.69 x 10(-5)) level was not significantly different from that of 35 normal controls (11.20 x 10(-5) +/- 2.92 x 10(-5)). However, this level was significantly increased (p < 0.05) in the plasma of 17 patients with developing metastasis (21.02 x 10(-5) +/- 4.68 x 10(-5)).

Agouti alleles alter cysteine and glutathione concentrations in hair follicles and serum of mice (A y/a, A wJ/A wJ, and a/a)

Ectopic overexpression of the agouti protein in the lethal yellow (A y/a) mouse causes a yellow coat as well as the lethal yellow syndrome. Presence of thiols like glutathione (GSH) or cysteine (Cys) may regulate the conversion of dopaquinone to phaeomelanin in hair follicle melanocytes. GSH also plays important roles in cellular health and maintenance. Cys and GSH were measured using high-performance liquid chromatography in hair follicles and serum of A wJ/A wJ (agouti), A y/a (yellow), and a/a (black) mice over a 20-d hair growth regeneration period. Agouti alleles modulate thiol concentrations. A y/a hair follicles exhibited higher total thiol levels and an increased ratio of Cys to GSH. A wJ/A wJ mice showed intermediate levels, while a/a mice had lowest total thiol concentrations and a decreased ratio of Cys to GSH. Hair follicle cysteine concentrations showed yellow > agouti > black (p < 0.01). In all genotypes, unplucked skin and day 0 hair follicles showed GSH as the major thiol, but a shift to predominantly Cys on peak melanogenic days was seen. Presence of high concentrations of free cysteine support the hypothesis of phaeomelanin synthesis via cysteinyldopas. The A y/a mouse had the most dramatic follicular thiol changes as well as a depression in serum thiols. An altered thiol metabolism in these and other A y/a tissues might impair normal cell functioning to contribute to the lethal yellow syndrome.

Seasonal variation in serum concentration of 5-S-cysteinyldopa and 6-hydroxy-5-methoxyindole-2-carboxylic acid in healthy Japanese

Serum concentrations of 5-S-cysteinyldopa (5-S-CD) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) have been used as biochemical markers of melanoma progression. We examined the effect of solar radiation on serum levels of 5-S-CD and 6H5MI2C in 10 healthy Japanese by measuring these markers every month during a period of 2 years. 5-S-CD levels were higher in early summer and lower in early winter. The difference in the average levels was approximately twofold, but among the 240 samples, no individual values exceeded the upper limit of normal value, 10 nmol/L. A significant correlation (P < 0.02) was observed between 5-S-CD level and solar radiation. 6H5MI2C levels showed a smaller variation than 5-S-CD. No correlation was observed between 6H5MI2C level and solar radiation. This study showed that serum 5-S-CD and 6H5MI2C in healthy Japanese did not exceed the upper limit of normal values even in sunny season.