The measurement of pyridinium crosslinks: a methodological overview

FLIm-Guided Raman Imaging to Study Cross-Linking and Calcification of Bovine Pericardium

Bovine pericardium (BP) is a vascular biomaterial used in cardiovascular surgery that is typically cross-linked for masking antigenicity and enhance stability. There is a need for biochemical evaluation of the tissue properties prior to implantation to ensure that quality and reliability standards are met. Here, engineered antigen removed BP (ARBP) that was cross-linked with 0.2% and 0.6% glutaraldehyde (GA), and further calcified in vitro to simulate graft calcifications upon implantation was characterized nondestructively using fluorescence lifetime imaging (FLIm) to identify regions of interest which were then assessed by Raman spectroscopy. We observed that the tissue fluorescence lifetime shortened, and that Raman bands at 856, 935, 1282, and 1682 cm-1 decreased, and at 1032 and 1627 cm-1 increased with increasing GA cross-linking. Independent classification analysis based on fluorescence lifetime and on Raman spectra discriminated between GA-ARBP and untreated ARBP with an accuracy of 91% and 66%, respectively. Pearson's correlation analysis showed a strong correlation between pyridinium cross-links measured with high-performance liquid chromatography and fluorescence lifetime measured at 380-400 nm (R = -0.76, p = 0.00094), as well as Raman bands at 856 cm-1 for hydroxy-proline (R = -0.68, p = 0.0056) and at 1032 cm-1 for hydroxy-pyridinium (R = 0.74, p = 0.0016). Calcified areas of GA cross-linked tissue showed characteristic hydroxyapatite (959 and 1038 cm-1) bands in the Raman spectrum and fluorescence lifetime shortened by 0.4 ns compared to uncalcified regions. FLIm-guided Raman imaging could rapidly identify degrees of cross-linking and detected calcified regions with high chemical specificity, an ability that can be used to monitor tissue engineering processes for applications in regenerative medicine.

Chemical structure, biosynthesis and synthesis of free and glycosylated pyridinolines formed by cross-link of bone and synovium collagen

This review focuses on the chemical structure, biosynthesis and synthesis of free and glycosylated pyridinolines (Pyds), fluorescent collagen cross-links, with a pyridinium salt structure. Pyds derive from the degradation of bone collagen and have attracted attention for their use as biochemical markers of bone resorption and to assess fracture risk prediction in persons suffering from osteoporosis, bone cancer and other bone or collagen diseases. We consider and critically discuss all reported syntheses of free and glycosylated Pyds evidencing an unrevised chemistry, original and of general utility, analysis of which allows us to also support a previously suggested non-enzymatic formation of Pyds in collagen better rationalizing and justifying the chemical events.

Biochemical markers of bone turnover - uses and limitations

Bone turnover markers of resorption and formation are released during the process of bone remodelling. These markers have been extensively studied in a number of therapeutic trials of osteoporosis during the past decade. This has led to better understanding of their physiology, clinical applications and possible ways to optimize analytical techniques. Bone markers can complement the results of bone mineral density in the management of osteoporosis, but their use in clinical practice is challenged by pre-analytical and analytical variability. This review will discuss different types of bone markers, their limitations, use in different metabolic bone diseases and current recommendations from the International Osteoporosis Foundation and the International Federation of Clinical Chemistry and Laboratory Medicine bone marker standards working group.

Simultaneous free and glycosylated pyridinium crosslink determination in urine: validation of an HPLC-fluorescence method using a deoxypyridinoline homologue as internal standard

Pyridinoline (Pyr), deoxypyridinoline (D-Pyr), galactosyl-pyridinoline (Gal-Pyr) and glucosyl-galactosyl pyridinoline (GluGal-Pyr) are enzymatic mature pyridinium crosslinks. Generally, only total Pyr and D-Pyr urinary amounts (free+bound forms) are evaluated by HPLC as indices of bone resorption. This report describes the validation of an HPLC-fluorescence method for the simultaneous evaluation of free Pyr and D-Pyr, together with GluGal-Pyr and Gal-Pyr, in urine of healthy women (n=20, aged 27-41) and girls (n=20, aged 5-10). The use of an unnatural D-Pyr homologue, here proposed for the first time as internal standard, and of pure Pyr, D-Pyr, GluGal-Pyr and Gal-Pyr synthesized to be used as primary calibrators, guarantees method specificity and correct crosslink quantification. Urine, spiked with IS, was solid-phase extracted prior to HPLC analysis. Total Pyr and D-Pyr amounts were also evaluated after urine hydrolysis. The HPLC method was validated for selectivity, sensitivity, linearity, precision, accuracy, recovery and stability for all measured crosslinks. Both free and total Pyr and D-Pyr as well as GluGal-Pyr and Gal-Pyr amounts were significantly higher in girls than in women (p<0.0001), indicating an increased collagen turnover rather than only bone turnover. Gal-Pyr, for the first time evaluated in girls, was under its lower quantification limit (<LLOQ, <21.20 pmol/mL) in women. The measurement of free and glycosylated pyridinium crosslinks might provide more information on the degradation of various types of collagen than only that of total Pyr and D-Pyr. Moreover, this validated method could be a useful non-invasive technique for studying pathological conditions characterized by modified glycosylation enzyme activity and for more clinical investigation on bone fragility.

Practical syntheses of pyridinolines, important amino acidic biomarkers of collagen health

The paper reports some successful results on the first fully stereoselective total synthesis of the collagen cross-link pyridinolines. All stereogenic centers are stereoselectively introduced using Williams glycine template methodology, and oxazinones are used as a source of chirality and as easily removable protecting groups of the amino acidic functionalities during the assembly of the pyridinoline nucleus.

Ultraviolet photolysis of urine for suppression of color quenching prior to liquid scintillation counting of tritium

In order to reduce the color quenching in the measurement of tritium in urine by liquid scintillation counting , UV irradiation was applied to decompose the organic substances in the sample. Urine was decolorized under UV irradiation in the presence of hydrogen peroxide. As a result, color quenching was considerably suppressed and higher counting efficiency of tritium was obtained. This UV treatment made it possible to increase the urine content in the sample from 2 to 40% (v/v) without significant decrease of counting efficiency. Either higher sensitivity or shorter analysis time was achieved in the tritium measurement by the augmentation of urine content. When the measurement time was 30 min, the detection limit of tritium defined as 3s was 0.03 Bq/ml. At the expense of some sensitivity (set at a detection limit of 0.3 Bq/ml), the measurement time was shortened to 0.5 min. These results will make a great improvement to routine tritium monitoring as well as to emergency monitoring in mass tritium exposure.

High-performance liquid chromatography method to analyze free and total urinary pyridinoline and deoxypyridinoline

The pyridinium cross-links pyridinoline (PYD) and deoxypyridinoline (DPD) are established markers of bone resorption measured in blood and urine and are used to investigate bone metabolism and manage bone diseases. Unfortunately, the currently observed interlaboratory variability caused by inconsistent assay calibration limits the optimal use of these markers. A high-performance liquid chromatography (HPLC)-based assay was developed using synthetic PYD and DPD as calibrators to analyze free and total PYD and DPD in urine. The spectroscopic characteristics of the synthetic calibrators were identical to those of calibrators isolated from bone. The mean intraassay variabilities of the HPLC method were 4.1 and 3.8%, respectively, for total DPD and PYD and 9.8 and 9.5%, respectively, for free DPD and PYD. The mean interassay variabilities were 9.1 and 8.2% for total DPD and PYD and 8.6 and 7.0% for free DPD and PYD, respectively. The mean recoveries were 98.1% for total DPD, 100.8% for total PYD, 98.6% for free DPD, and 94.9% for free PYD. The method exhibits a good correlation with a commercial immunoassay and with other HPLC assays currently used in hospital laboratories.

Assessment and Recommendations on Factors Contributing to Preanalytical Variability of Urinary Pyridinoline and Deoxypyridinoline

Background: Pyridinoline (PYD) and deoxypyridinoline (DPD) are two of the most extensively characterized biochemical bone markers, but the interpretation of results is hampered by biologic and other preanalytical variability. We reviewed factors contributing to preanalytical variation of pyridinium cross-links in urine.

Methods: We searched four databases for English-language reports on PYD and/or DPD in urine. Searches were restricted to humans, except for studies of stability, when the search was expanded to other species. The 599 identified articles were supplemented with references from those articles and with articles known to the authors.

Results: The mean reported within-day variability was 71% for PYD (range, 57–78%) and 67% for DPD (range, 53–75%). The mean interday variability was 16% for both DPD and PYD (range for PYD, 12–21%; range for DPD, 5–24%). The mean intersubject variabilities across studies were 26% for PYD (range, 12–63%) and 34% for DPD (range, 8–98%) for healthy premenopausal women and 36% (range, 22–61%) and 40%, (range, 27–54%) for postmenopausal women, respectively. Specimen instability and errors in creatinine measurements were additional sources of variability.

Conclusions: Intra- and intersubject variability can be reduced by collecting specimens at a specific time of the day and by maintaining similar patient status at each specimen collection regarding factors such as medications and dietary supplements.

Biochemical markers of bone turnover

BACKGROUND

Osteoporosis in many countries has reached epidemic proportions. This has stimulated the development of biochemical markers to assist in the assessment of osteoporotic risk and in monitoring the efficacy of treatment. Biochemical markers of bone turnover are products released from osteoblasts and osteoclasts or collagen breakdown products.

MARKERS

Markers of bone formation include bone-specific alkaline phosphatase (BAP), osteocalcin (OC) and procollagen peptides. All of these can be measured easily by immunoassay techniques. Of these markers, OC has been extensively studied. However, OC undergoes in vitro degradation, thus, assay results are variable. BAP, on the other hand, is much more stable and shows less within-person biological variation. Bone resorption markers include tartrate-resistant acid phosphatase (TRAP) and collagen breakdown products, such as pyridinium cross-links, galactosyl hydroxylysine and cross-linked telopeptides, such as CTx and NTx. Of these, deoxypyridinium (DPD) has been extensively studied. DPD shows diurnal variation and the within-individual biological variation is large. Of the newer assays, NTx appear to show large differences at menopause.

CONCLUSIONS

Thus, serum BAP and DPD or NTx are the current choice of bone markers.

External quality assessment of bone metabolism marker assays. initial experiences in a UK NEQAS programme

This paper reports on a pilot external quality assessment scheme for bone markers including serum bone alkaline phosphatase and procollagen 1-carboxy terminal propeptide together with urine deoxypyridinoline, N- and C-telopeptides. The data shows poor numerical agreement between commercial assays, between-laboratory imprecision that could be improved, and the need for international standardisation of assays.

Synthesis of immunoreagents for detection of deoxypyrrololine, a cross-link of bone collagen

Two immunogens (5,6) and two probes (fluorescent 7 and chemiluminescent 8) were prepared from benzyl ester (-)-10. These immunoreagents (5,6 and 7,8) are useful for detection of collagen cross-link (+)-deoxypyrrololine (Dpl, 4), and for development of assays for osteoporosis.

Clinical usefulness of biochemical resorption markers in osteoporosis

We have evaluated three commercial assays for collagen cross-links, two urine assays and a recently developed serum assay, as markers of bone turnover in 30 postmenopausal women with osteoporosis during their first year of treatment with the anti-resorptive drug alendronate. Before treatment, urine free deoxypyridinoline crosslinks (Dpd), urine N-telopeptide crosslinks (NTx) and serum C-telopeptide (CTx) values were within postmenopausal reference ranges. After 3 months' treatment the decrease in NTx and CTx was greater than that of Dpd (-50%, P < 0.0001 and -48%, P < 0.0001, compared with -11%, NS), as it was after 6 months (-51%, P < 0.0001, and -57%, P < 0.0001, compared with -19%, P < 0.01). The decrease in resorption markers after 6 months was significant in 23% (Dpd), 66% (NTx) and 66% (CTx) of individuals. Neither baseline resorption marker values nor the per cent change after 6 months' therapy correlated with bone mineral density change (BMD) at either lumbar spine or femoral neck after one year's therapy, except baseline Dpd and lumbar spine BMD (P < 0.01). We conclude that NTx and serum CTx were more sensitive markers of bone turnover suppression by alendronate, but only baseline Dpd was useful in the prediction of individual bone density response after one year.

Study of the cell biology and biochemistry of cherubism

AIMS

To establish whether the multinucleate cells in lesions of patients with cherubism are also osteoclasts and if this is the case whether they were responsive to calcitonin; to carry out cytogenetic studies on two members of the same family affected by cherubism in an attempt to identify any major chromosomal defects; and to perform an in-depth modern biochemical study of four children in the same family.

SUBJECTS AND METHODS

Four related children with cherubism were studied. Tissue taken from one of the children at elective decompression of an optic nerve was submitted to in vitro bone resorption studies. Cytogenetic studies were done on two of the children and biochemical studies on all four.

RESULTS

The multinucleate cells in the cherubic lesions were shown to be osteoclasts since they synthesised tartrate resistant acid phosphatase, expressed the vitronectin receptor, and resorbed bone. Bone resorption by the cultured multinucleate cells was significantly inhibited by calcitonin. High resolution cytogenetic studies failed to detect any chromosomal abnormalities in two children with cherubism. The biochemistry profile of all four children with cherubism showed that serum calcium, parathyroid hormone, parathyroid related hormone, calcitonin, and alkaline phosphatase were within normal levels. Urine analysis of pyridinium and deoxypyridinium cross links, hydroxyproline, and calcium in relation to urine creatinine were measured to assess bone resorption in these children, and the values were at the upper end of the normal range in all four.

CONCLUSIONS

Further studies are required to determine whether calcitonin treatment will control this grossly deforming disease until the time when the physiological changes that occur at puberty rectify the pathology. It is not recommended that biochemical markers of bone resorption are used in isolation to monitor the activity of cherubism in individuals because the results are based on a small number of children and because of reports of marked interindividual variation in the levels of these markers, particularly in children.

Comparison of bone resorption markers during hypocalcemia in dairy cows

This study investigated whether hydroxyproline, deoxypyridinoline, or the carboxyterminal telopeptide of type I collagen could be used as markers to provide evidence of bone resorption during hypocalcemia of dairy cows. Serum concentrations of the amino-terminal propeptide of type III procollagen were also analyzed to study the effect of parturition on type III collagen, which is a component of soft connective tissues. Urine and blood samples were collected on d 1 to 5, on d 9, and d 14 after parturition from 18 cows with symptoms of periparturient paresis (group 1) and 19 healthy control cows without symptoms (group 2). Urine concentrations of hydroxyproline and deoxypyridinoline were measured with a colorimetric assay and an enzyme immunoassay, respectively. Serum concentrations of the amino-terminal propeptide of type III procollagen were measured using a commercially available radioimmunoassay. A radioimmunoassay was developed to analyze serum concentrations of the carboxyterminal telopeptide of bovine type I collagen. The mean corrected urinary hydroxyproline concentrations in group 1 increased from parturition to d 14; concentrations in group 1 were significantly higher for group 2 after d 5. Mean corrected deoxypyridinoline concentrations in urine increased after parturition to reach a peak at d 9, and serum concentrations of the carboxyterminal telopeptide of type I collagen peaked at d 5. However, mean concentrations of deoxypyridinoline and the carboxyterminal telopeptide of type I collagen did not differ significantly between groups. The variation in the behavior of the three markers is likely a reflection of the different phases and aspects of the bone collagen degradation. In conclusion, assays for urinary deoxypyridinoline and serum carboxyterminal telopeptide of type I collagen determinations are useful tools to follow the course of degradation of bone collagen in dairy cows.

Serum collagen crosslinks as markers of bone turn-over during GH replacement therapy in growth hormone deficient adults

OBJECTIVES

Bone metabolism is an important target for GH replacement therapy. However, in adults, treatment periods exceeding 12 months are required for a positive effect of GH on bone mineral density. Thus, to detect an early effect of GH on bone, markers of bone turn-over are important. Pyridinoline (PYR) and deoxypyridinoline (DPYR) are well-defined sensitive markers of bone resorption, but to date only urinary assays have been available. We report the use of a novel assay to measure changes in serum PYR and DPYR in GH deficient (GHD) adults during GH replacement therapy.

STUDY DESIGN

The study consisted of a 6-month randomized, double-blind, placebo-controlled study of the administration of GH (Genotropin) (0.25 IU/Kg/week (0.125 IU/kg/week for the first four weeks)) followed by a 6-month open phase of GH therapy.

PATIENTS

Thirty-five GHD adults (17 women; mean age 39.8 years; range 21.1-59.9) on conventional hormone replacement therapy as required, were studied.

MEASUREMENTS

Bone formation was analysed using serum bone alkaline phosphatase (BAP) and serum osteocalcin (OC). Bone resorption was analysed using serum pyridinoline (PYR) and serum deoxypyridinoline (DPYR). Bone mineral density (BMD) was determined by dual energy X-ray absorptiometry (DEXA).

RESULTS

After 6 months placebo treatment there were no significant changes in any of the bone markers analysed, nor in BMD. In the active arm of the study there was a significant increase in serum OC, BAP, PYR and DPYR (P = 0.03, P = 0.004, P = 0.003 and P = 0.01, respectively), remaining significantly elevated over their baseline levels for the subsequent 6 months of treatment (P = 0.04, P = 0.009, P = 0.003 and P = 0.04, respectively). No changes were observed in BMD in any of the groups after 6 months GH treatment. In the active arm of the study, after 12 months GH treatment there was a significant increase in BMD at both the lumbar spine and femoral neck (P = 0.01 for both sites).

CONCLUSIONS

In summary, the present study confirms that administration of GH treatment to GHD adult patients significantly activates bone remodelling, with the effect of GH both in bone formation and bone resorption markers being maximal after 6 months of treatment. The serum assay for PYR and DPYR has a number of practical and theoretical advantages over the urine assay and gave similar results to those previously reported for the urine assay.

Urinary excretion of pyridinium crosslinks and N-terminal crosslinked peptide in preterm and term infants

Urinary excretion of pyridinium crosslinks of collagen, pyridinoline, deoxypyridinoline, and N-terminal crosslinked peptide are now widely used as biochemical markers of bone resorption. In the present cross-sectional study we measured the urinary excretion of total pyridinoline and total deoxypyridinoline by HPLC and N-terminal crosslinked peptide by ELISA in 43 preterm and term newborns in the first 2 months of life. The infants had no history of endocrine or metabolic diseases, bone, chronic heart, or pulmonary diseases. The results were compared by parametric covariance analysis, the HPLC and ELISA results by the Bland-Altman plot. Preterm infants had a statistically higher level of pyridinium crosslinks and N-terminal crosslinked peptide in urine (P < 0.05) than term infants. The very low birthweight infants (gestational age 26-32 weeks) had the highest levels of pyridinoline, deoxypyridinoline and N-terminal crosslinked peptide. Levels of both pyridinium crosslinks and N-terminal crosslinked peptide were independent of sex (P > 0.05). The Bland-Altman plot showed a good agreement between the levels of pyridinium crosslinks and N-terminal crosslinked peptide. Measurement of pyridinium crosslinks and N-terminal crosslinked peptide excretion in small infants gives information about skeletal growth and individual bone turnover, which is dependent on gestational age and birthweight. HPLC and ELISA are reliable methods for the measurement of pyridinium crosslinks and N-terminal crosslinked peptide, respectively.

Automated on-line solid-phase extraction and high-performance liquid chromatographic analysis of total and free pyridinium crosslinks in serum

An automated on-line solid-phase extraction procedure for free and total pyridinium crosslinks in serum, with HPLC analysis, is described. The pyridinium crosslinks either following hydrolysis in 3 M HCl or free in neat serum were extracted using a Gilson Aspec XLi system onto extraction cartridges containing an octylsilane/cation exchanger sorbent. Up to 525 microliters of serum could be loaded onto the extraction cartridges. After washing, the crosslinks were eluted with 400 microliters of 100 mM sodium formate pH 5 and 380 microliters of this was concentrated on a RPB guard column eluted with 100 mM HFBA. The crosslinks were backflushed and separated on a 5-micron ODS analytical column eluted with 30 mM HFBA with 18% MeCN at 1 ml/min and detected by their native fluorescence (excitation 295 nm, emission 400 nm). The use of a high sensitivity fluorescence detector was essential. Recoveries were 95-100% with a limit of detection (S/N = 2) of 109 pmol/l (pM) for pyridinoline (Pyr) and 143 pM for deoxypyridinoline (dPyr). The inter-assay R.S.D. was 9% for pyridinoline and 10.8% for deoxypyridinoline. The throughput of the system was up to 50 samples per day.

Sensitive fluorimetric quantitation of pyridinium and pentosidine crosslinks in biological samples in a single high-performance liquid chromatographic run

A high-performance liquid chromatographic assay was developed for pyridinium crosslinks and pentosidine in mature collagen of a wide variety of connective tissue hydrolysates by a simple two-step isocratic assay using a reversed-phase column. The crosslinks (including the internal standard pyridoxine) were optimally detected by their native fluorescence by switching wavelengths of the detector during the assay. The method resulted in highly sensitive and accurate measurements, without need for precleaning of the samples: crosslink levels in 200 microm thin slices of the various zones of articular cartilage were easily quantified. The detection limit was as low as 0.4 pmol for the pyridinolines and 0.05 pmol for pentosidine. The intra-assay and inter-assay coefficients of variation were as low as 2% (pyridinolines) and 5% (pentosidine); calibration curves for all compounds were linear over a concentration range larger than two orders of magnitude. With our chromatographic system, the diglycosylated form of hydroxylysylpyridinoline in unhydrolyzed urine was separated as well.