Simultaneous determination of cortisol and cortisone from human serum by liquid chromatography-tandem mass spectrometry

Hair glucocorticoid levels decrease after multimodal inpatient treatment and predict therapy outcome in burnout-related depressive disorders

OBJECTIVES

Hair cortisol concentration (HCC) indicates chronic stress exposure, which is a risk factor in the pathogenesis of burnout and depression. However, findings on HCC are inconsistent. Similarly, intervention studies show mixed effects on HCC. The present study aimed to shed light on these inconsistencies, by additionally considering also hair cortisone.

METHODS

Twenty-five patients with a burnout-related depressive disorder receiving a multimodal inpatient treatment for clinical burnout and 17 matched healthy controls participated in this study. All participants provided 1 cm long hair samples at the beginning and end of the treatment. HCC and hair cortisone levels (HCNC) were determined. Meteorological data and duration of sick leave were considered as potential covariates. Burnout and depression were assessed with self-ratings, the latter also with examiner ratings.

RESULTS

There were no significant group differences in glucocorticoid levels. Treatment led to a decrease in both depression severity and hair glucocorticoid concentration in inpatients, while lower HCNC in particular predicted a greater reduction in depression severity. Moreover, meteorological data and the duration of sick leave were also found to have an effect on hair glucocorticoid concentrations.

CONCLUSIONS

These results suggest that multimodal inpatient treatment of clinical burnout considerably reduced stress on both a psychological and biological level. In parallel, hair glucocorticoids appear to be sensitive biomarkers for the evaluation of treatment success and prediction. Examining both HCC and HCNC in intervention studies may provide clearer results than the usual examination of HCC alone.

A biomarker panel of secondary hypertension is simultaneously quantified by coupling of magnetic solid-phase extraction and liquid chromatography-tandem mass spectrometry

RATIONALE

Secondary hypertension is often caused by activation of complex multi-organ endocrine systems, while renin activity indicated by angiotensins (Angs), aldosterone (ALD) and cortisol (COR) in such systems are generally accepted as its diagnostic markers. As antibody-based methods cannot offer comparable quantification for these biomarkers, a liquid chromatography (LC)-tandem mass spectrometry (MS/MS)-based approach was developed to quantify them simultaneously and accurately.

METHODS

Five different beads for magnetic solid-phase extraction (MSPE) were evaluated towards their enrichment efficiency for these biomarkers. An LC system with optimized elution gradient and a triple-quadrupole MS with tuned parameters were coupled to quantitatively monitor the extracted analytes. The method performance was further examined such as linearity, precision, stability, recovery rate and matrix effect. Based on the developed method, the abundance of Ang II, ALD and COR in plasma was measured and the quantification was compared with that derived from commercial ELISA kits.

RESULTS

As compared with other MSPEs, Angs, ALD and COR were highly enriched by the HLB magnetic beads with satisfactory recoveries. These analytes were simultaneously quantified by LC/MS/MS and all the method parameters for quantification were well matched with the requirements of clinical testing. Comparison of the quantitative results derived from ELISA and LC/MS/MS exhibited that the two methods offered basically comparable values with Pearson r values at 0.896, 0.895 and 0.835, respectively. The stability test for plasma Angs at room temperature indicated that the abundance of Ang II was relatively stable within 3 h, whereas that of Ang I and Ang 1-7 was time-dependently changed.

CONCLUSIONS

Coupling of HLB beads and LC/MS/MS thus enables simultaneous quantification of a set of biomarkers related to secondary hypertension.

Highly Responsive Bioassay for Quantification of Glucocorticoids

Measurement of total cortisol levels in serum samples is currently based on immunoassays or liquid chromatography-mass spectrometry (LC-MS/MS). However, measurement of bioavailable cortisol is laborious, unreliable, and inconvenient for the patient. Therefore, a new versatile assay with the ability to measure both total and bioavailable cortisol from serum represents an important supplement to the current methods. We have generated a cell-based glucocorticoid reporter assay (HEK293F-GRE). The assay was validated for cell line stability, accuracy by dilution, precision, repeatability, reproducibility, and specificity. Additionally, the assay was tested for measuring both total and bioavailable cortisol in serum. The assay showed linearity at five dilution levels with R2 = 0.98 and an accuracy between 0.8 and 1.2. Precision (CV < 20%) was validated down to 3-6 nM dexamethasone, and estimation of the total cortisol concentration was comparable to cortisol immunoassay and LC-MS/MS in most serum samples. Moreover, the assay estimated the bioavailable cortisol fraction in serum samples to a level that agreed with the literature. The HEK293F-GRE assay holds the potential to be a complementary method for estimating cortisol in clinical practice. The ability to quantify bioavailable cortisol directly from serum samples is alluring and provides an opportunity for monitored and personal dose regimens of exogenous glucocorticoids.

Recent advances in aptamer-based platforms for cortisol hormone monitoring

The stressful conditions of today-life make it urgent the timely prevention and treatment of many physiological and psychological disorders related to stress. According to the significant progress made in the near future, rapid, accurate, and on-spot measurement of cortisol hormone as a dominant stress biomarker using miniaturized digital devices is not far from expected. With a special potency in the fields of diagnosis and healthcare monitoring, aptamer-mediated biosensors (aptasensors) are promising for the quantitative monitoring of cortisol levels in the different matrices (sweat, saliva, urine, cerebrospinal fluid, blood serum, etc.). Accordingly, this in-depth study reviews the superior achievements in the aptasensing strategies to detect cortisol hormone with the synergism of diverse two/three dimensional nanostructured materials, enzymatic amplification components, and antibody motifs. The represented discussions offer a universal perspective to achieve lab-on-chip aptasensing arrays as future user-friendly skin-patchable electronic gadgets for on-site and real-time quantification of cortisol levels.

In vitro methods to assess 11β-hydroxysteroid dehydrogenase type 1 activity

11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) converts inactive 11-keto-glucocorticoids to their active 11β-hydroxylated forms. It also catalyzes the oxoreduction of other endogenous and exogenous substrates. The ubiquitously expressed 11β-HSD1 shows high levels in liver and other metabolically active tissues such as brain and adipose tissue. Pharmacological inhibition of 11β-HSD1 was found to ameliorate adverse metabolic effects of elevated glucocorticoids in rodents and humans, improve wound healing and delay skin aging, and enhance memory and cognition in rodent Alzheimer's disease models. Thus, there is an interest to develop 11β-HSD1 inhibitors for therapeutic purposes. This chapter describes in vitro methods to assess 11β-HSD1 enzyme activity for different purposes, be it in disease models, for the assessment of the kinetics of novel substrates or for the screening and characterization of inhibitors. 11β-HSD1 protein expression and preparations of the different biological samples are discussed first, followed by a description of a well-established and easily adaptable 11β-HSD1 enzyme activity assay. Finally, different readout methods are shortly described. This chapter should provide the reader with a toolbox of methods to assess 11β-HSD1 activity with instructions in the form of a decision tree for the choice and implementation of an appropriate enzyme activity assay.

Molecularly Imprinted Polymer-Based Sensor for Electrochemical Detection of Cortisol

As a steroid hormone, cortisol has a close relationship with the stress response, and therefore, can be used as a biomarker for early detection of stress. An electrochemical immunosensor is one of the most widely used methods to detect cortisol, with antibodies as its bioreceptor. Apart from conventional laboratory-based methods, the trend for cortisol detection has seemed to be exploiting antibodies and aptamers. Both can provide satisfactory performance with high selectivity and sensitivity, but they still face issues with their short shelf life. Molecularly imprinted polymers (MIPs) have been widely used to detect macro- and micro-molecules by forming artificial antibodies as bioreceptors. MIPs are an alternative to natural antibodies, which despite demonstrating high selectivity and a low degree of cross-reactivity, often also show a high sensitivity to the environment, leading to their denaturation. MIPs can be prepared with convenient and relatively affordable fabrication processes. They also have high durability in ambient conditions, a long shelf life, and the ability to detect cortisol molecules at a concentration as low as 2 ag/mL. By collecting data from the past five years, this review summarizes the antibody and aptamer-based amperometric sensors as well as the latest developments exploiting MIPs rather than antibodies. Lastly, factors that can improve MIPs performance and are expected to be developed in the future are also explained.

Nanomaterials for Cortisol Sensing

Space represents one of the most dangerous environments for humans, which can be affected by high stress levels. This can lead to severe physiological problems, such as headaches, gastrointestinal disorders, anxiety, hypertension, depression, and coronary heart diseases. During a stress condition, the human body produces specific hormones, such as dopamine, adrenaline, noradrenaline, and cortisol. In particular, the control of cortisol levels can be related to the stress level of an astronaut, particularly during a long-term space mission. The common analytical methods (HPLC, GC-MS) cannot be used in an extreme environment, such as a space station, due to the steric hindrance of the instruments and the absence of gravity. For these reasons, the development of smart sensing devices with a facile and fast analytical protocol can be extremely useful for space applications. This review summarizes the recent (from 2011) miniaturized sensoristic devices based on nanomaterials (gold and carbon nanoparticles, nanotubes, nanowires, nano-electrodes), which allow rapid and real-time analyses of cortisol levels in biological samples (such as saliva, urine, sweat, and plasma), to monitor the health conditions of humans under extreme stress conditions.

Cortisol Detection in Undiluted Human Serum Using a Sensitive Electrochemical Structure-Switching Aptamer over an Antifouling Nanocomposite Layer

There is a strong and growing need to monitor stress biomarkers in vivo for real-time emotional and wellness assessment. Toward this, we report a reagent-free electrochemical aptasensor with a nanocomposite antifouling layer for sensitive and continuous detection of cortisol in human serum. A thiolated, methylene blue (MB)-tagged conformation-switching aptamer was immobilized over a gold nanowire (AuNW) nanocomposite to capture cortisol and generate a signal proportional to the cortisol concentration. The signal is recorded through differential pulse voltammetry (DPV) and chronoamperometry. The aptasensor exhibited a sensitive response with 0.51 and 0.68 nM detection limits in spiked buffer and undiluted serum samples, respectively. Interference from other structurally similar analogs, namely, epinephrine and cholic acid, was negligible (<10%). The developed nanocomposite-based aptasensor showed excellent stability in undiluted human serum, outperforming several other nanocomposite materials even after prolonged exposure. This work lays the foundation for new biosensor formats such as implantable and wearable sensors.

Immunosensor for Assessing the Welfare of Trainee Guide Dogs

Cortisol is a well established biomarker hormone that regulates many processes in the body and is widely referred to as the stress hormone. Cortisol can be used as a stress marker to allow for detection of stress levels in dogs during the training process. This test will indicate if they will handle the stress under the training or if they might be more suitable as an assistant or companion dog. An immunosensor for detection of cortisol was developed using electrochemical impedance spectroscopy (EIS). The sensor was characterized using chemical and topographical techniques. The sensor was calibrated and its sensitivity determined using a cortisol concentration range of 0.0005 to 50 μg/mL. The theoretical limit of detection was found to be 3.57 fg/mL. When the immunosensor was tested on canine saliva samples, cortisol was detected and measured within the relevant physiological ranges in dogs.

Sample Preparation and Analytical Methods for Steroid Hormones in Environmental and Food Samples: An Update Since 2012

Steroid hormones (SHs) have been widely used over the past few decades as both human and veterinary drugs to prevent or treat infectious diseases and anti-inflammatory benefits in clinical. Unfortunately, their residues in foodstuffs and environmental samples can produce adverse effects on human and animal life such as disrupting the endocrine system. For these reasons, sensitive, simple and efficient methods have been developed for the determination of these compounds in various matrices. This critical review summarized the articles published in the period from 2012 to 2019 and can be used to help researchers to understand development of the sample pretreatment protocols and analytical methods used to detect SHs. The developed extraction and purification techniques used for steroids in different samples, such as cloud point extraction, solid phase extraction based on different novel materials, microextraction methods, QuEChERS and other methods are summarized and discussed. Analytical methods used to quantify these compounds, such as different chromatography methods, electrochemical methods, as well as other methods, are illustrated and compared. We focused on the latest advances in SHs pretreatment, and the application of new technologies in SHs analysis.

The VH framework region 1 as a target of efficient mutagenesis for generating a variety of affinity-matured scFv mutants

In vitro affinity-maturation potentially generates antibody fragments with enhanced antigen-binding affinities that allow for developing more sensitive diagnostic systems and more effective therapeutic agents. Site-directed mutagenesis targeting “hot regions,” i.e., amino acid substitutions therein frequently increase the affinities, is desirable for straightforward discovery of valuable mutants. We here report two “designed” site-directed mutagenesis (A and B) targeted the N-terminal 1–10 positions of the V_H framework region 1 that successfully improved an anti-cortisol single-chain Fv fragment (K_a, 3.6 × 10⁸ M⁻¹). Mutagenesis A substituted the amino acids at the position 1–3, 5–7, 9 and 10 with a limited set of substitutions to generate only 1,536 different members, while mutagenesis B inserted 1–6 random residues between the positions 6 and 7. Screening the resulting bacterial libraries as scFv-phage clones with a clonal array profiling system provided 21 genetically unique scFv mutants showing 17–31-fold increased affinity with > 10⁹ M⁻¹K_a values. Among the mutants selected from the library A and B, scFv mA#18 (with five-residue substitutions) and mB_1-3#130 (with a single residue insertion) showed the greatest K_a value, 1.1 × 10¹⁰ M⁻¹.

Endogenous Glucocorticoid Metabolism in Bone: Friend or Foe

The role of tissue specific metabolism of endogenous glucocorticoids (GCs) in the pathogenesis of human disease has been a field of intense interest over the last 20 years, fuelling clinical trials of metabolism inhibitors in the treatment of an array of metabolic diseases. Localised pre-receptor metabolism of endogenous and therapeutic GCs by the 11β-hydroxysteroid dehydrogenase (11β-HSD) enzymes (which interconvert endogenous GCs between their inactive and active forms) are increasingly recognised as being critical in mediating both their positive and negative actions on bone homeostasis. In this review we explore the roles of endogenous and therapeutic GC metabolism by the 11β-HSD enzymes in the context of bone metabolism and bone cell function, and consider future strategies aimed at modulating this system in order to manage and treat various bone diseases.

The contribution of serum cortisone and glucocorticoid metabolites to detrimental bone health in patients receiving hydrocortisone therapy

BACKGROUND

Glucocorticoid therapy is the most common cause of iatrogenic osteoporosis. Less is known regarding the effect of glucocorticoids when used as replacement therapy on bone remodelling in patients with adrenal insufficiency. Enhanced intracellular conversion of inactive cortisone to active cortisol, by 11 beta-hydroxysteroid dehydrogenase type 1(11β-HSD1) and other enzymes leading to alterations in glucocorticoid metabolism, may contribute to a deleterious effect on bone health in this patient group.

METHODS

Study design: An open crossover prospective study randomizing ten hypopituitary men, with severe ACTH deficiency, to three commonly used hydrocortisone dose regimens.

MEASUREMENTS

Following 6 weeks of each regimen, patients underwent 24-h serum cortisol/cortisone sampling, measurement of bone turnover markers, and a 24-h urine collection for measurement of urinary steroid metabolites by gas chromatography-mass spectrometry (GC-MS). Serum cortisone and cortisol were analysed by liquid chromatography-mass spectrometry (LC-MS).

RESULTS

Dose-related and circadian variations in serum cortisone were seen to parallel those for cortisol, indicating conversion of ingested hydrocortisone to cortisone. The median area under the curve (AUC) of serum cortisone was significantly higher in patients on dose A (20 mg/10 mg) [670.5 (IQR 621-809.2)] compared to those on dose C (10 mg/5 mg) [562.8 (IQR 520.1-619.6), p = 0.01]. A negative correlation was observed between serum cortisone and bone formation markers, OC [1-49] (r = - 0.42, p = 0.03), and PINP (r = - 0.49, p = 0.01). There was a negative correlation between the AUC of night-time serum cortisone levels with the bone formation marker, OC [1-49] (r = - 0.41, p = 0.03) but there were no significant correlations between day-time serum cortisone or cortisol with bone turnover markers. There was a negative correlation between total urinary cortisol metabolites and the bone formation markers, PINP (r = - 0.39, p = 0.04), and OC [1-49] (r = - 0.35, p = 0.06).

CONCLUSION

Serum cortisol and cortisone and total urinary corticosteroid metabolites are negatively associated with bone turnover markers in patients receiving replacement doses of hydrocortisone, with nocturnal glucocorticoid exposure having a potentially greater influence on bone turnover.

TRIAL REGISTRATION

Irish Medicines Board Clinical Trial Number - CT900/459/1 and EudraCT Number - 2007-005018-37 . Registration date: 07-09-2007.

A Single-Step "Breeding" Generated a Diagnostic Anti-cortisol Antibody Fragment with Over 30-Fold Enhanced Affinity

Cortisol levels in bodily fluids represent a useful index for pituitary-adrenal function, and thus practical anti-cortisol antibodies are required. We have studied "antibody-breeding" approaches, which involve in vitro evolution of antibodies to improve their antigen-binding performances. Here, we produced an antibody fragment to measure serum cortisol levels with over 30-fold enhanced affinity after single mutagenesis and selection steps. A mouse anti-cortisol antibody, Ab-CS#3, with insufficient affinity for practical use, was chosen as the prototype antibody. A "wild-type" single-chain Fv fragment (wt-scFv; K_a, 3.4×10⁸ M^-1) was prepared by bacterial expression of a fusion gene combining the V_H and V_L genes for this antibody. Then, random point mutations were generated separately in V_H or V_L by error-prone PCR, and the resulting products were used to assemble scFv genes, which were displayed on filamentous phages. Repeated panning of the phage library identified a mutant scFv (scFv#m1-L10) with an over 30-fold enhanced affinity (K_a 1.2×10¹⁰ M^-1). Three amino acid substitutions (Cys49Ser, Leu54Pro, and Ser63Gly) were observed in its V_L sequence. In a competitive enzyme-linked immunosorbent assay (ELISA), the mutant scFv generated dose-response curves with measuring range ca. 0.03-0.6 ng/assay cortisol, midpoint of which (0.15 ng/assay) was 7.3-fold lower than that of wt-scFv. Although cortisone, 11-deoxycortisol, and prednisolone showed considerable cross-reactivity, the mutant scFv should enable sensitive routine cortisol assays, except for measurement after metyrapone or high-dose of prednisolone administrations. Actually, cortisol levels of control sera obtained with the scFv-based ELISA were in the reference range.

Nanoantenna-assisted plasmonic enhancement of IR absorption of vibrational modes of organic molecules

Nanoantenna-assisted plasmonic enhancement of IR absorption and Raman scattering was employed for studying the vibrational modes in organic molecules. Ultrathin cobalt phthalocyanine films (3 nm) were deposited on Au nanoantenna arrays with specified structural parameters. The deposited organic films reveal the enhancement of both Raman scattering and IR absorption vibrational modes. To extend the possibility of implementing surface-enhanced infrared absorption (SEIRA) for biological applications, the detection and analysis of the steroid hormone cortisol was demonstrated.

Measuring cortisol in serum, urine and saliva - are our assays good enough?

Cortisol is a steroid hormone produced in response to stress. It is essential for maintaining health and wellbeing and leads to significant morbidity when deficient or present in excess. It is lipophilic and is transported bound to cortisol-binding globulin (CBG) and albumin; a small fraction (∼10%) of total serum cortisol is unbound and biologically active. Serum cortisol assays measure total cortisol and their results can be misleading in patients with altered serum protein concentrations. Automated immunoassays are used to measure cortisol but lack specificity and show significant inter-assay differences. Liquid chromatography - tandem mass spectrometry (LC-MS/MS) offers improved specificity and sensitivity; however, cortisol cut-offs used in the short Synacthen and Dexamethasone suppression tests are yet to be validated for these assays. Urine free cortisol is used to screen for Cushing's syndrome. Unbound cortisol is excreted unchanged in the urine and 24-h urine free cortisol correlates well with mean serum-free cortisol in conditions of cortisol excess. Urine free cortisol is measured predominantly by immunoassay or LC-MS/MS. Salivary cortisol also reflects changes in unbound serum cortisol and offers a reliable alternative to measuring free cortisol in serum. LC-MS/MS is the method of choice for measuring salivary cortisol; however, its use is limited by the lack of a single, validated reference range and poorly standardized assays. This review examines the methods available for measuring cortisol in serum, urine and saliva, explores cortisol in disease and considers the difficulties of measuring cortisol in acutely unwell patients and in neonates.