HPLC–Tandem Mass Spectrometric Method for Rapid Quantification of Dimethylarginines in Human Plasma

Quantification of ADMA: analytical approaches

Methylated L-arginine analogs are involved in nitric oxide synthase activity regulation. Methods based on high-performance liquid chromatography with fluorescence, capillary electrophoresis, or ion exchange chromatography with absorbance detection were first applied for the quantitative determination of N-monomethyl-L-arginine (NMMA), asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in human blood and urine. These assays revealed elevated circulating levels of ADMA in various diseases and gave accumulating evidence of the usefulness of ADMA as a cardiovascular risk factor. However, the methods used are hampered by the fact that NMMA, ADMA and SDMA can be distinguished from L-arginine only by means of chromatographic separation. This has promoted the development of alternatives that involve mass spectrometry (MS) technology. Today, various MS-based approaches such as liquid chromatography (LC)-MS, LC-MS/MS, gas chromatography (GC)-MS, and GC-MS/MS are available. L-arginine and its analogs have been subjected to LC-MS analysis with and without further derivatization to their o-phthaldialdehyde derivatives. For these methods, labelled L-arginine was used as the internal standard. The first MS-based method that distinguishes NMMA, ADMA, SDMA and L-arginine by mass-to-charge (m/z)- ratio has been reported by Tsikas et al. This GC-MS approach has been further improved by Albsmeier et al by introducing labelled ADMA as an internal standard. As an alternative to existing methods, a commercially available ELISA kit has recently been developed and validated.

Resolution and quantification of arginine, monomethylarginine, asymmetric dimethylarginine, and symmetric dimethylarginine in plasma using HPLC with internal calibration

N(G) ,N(G) -dimethyl-l-arginine (asymmetric dimethylarginine, ADMA),N(G) -monomethyl-l-arginine (l-NMMA) and N(G) ,N(G') -dimethyl-l-arginine (symmetric dimethylarginine, SDMA) are released during hydrolysis of proteins containing methylated arginine residues. ADMA and l-NMMA inhibit nitric oxide synthase by competing with l-arginine substrate. All three methylarginine derivatives also inhibit arginine transport. To enable investigation of methylarginines in diseases involving impaired nitric oxide synthesis, we developed a high-performance liquid chromatography (HPLC) assay to simultaneously quantify arginine, ADMA, l-NMMA and SDMA. Our assay requires 12 μL of plasma and is ideal for applications where sample availability is limited. We extracted arginine and methylarginines with mixed-mode cation-exchange columns, using synthetic monoethyl-l-arginine as an internal standard. Metabolites were derivatized with ortho-phthaldialdeyhde and 3-mercaptopropionic acid, separated by reverse-phase HPLC and quantified with fluorescence detection. Standard curve linearity was ≥0.9995 for all metabolites. Inter-day coefficient of variation (CV) values were ≤5% for arginine, ADMA and SDMA in human plasma and for arginine and ADMA in mouse plasma. The CV value for l-NMMA was higher in human (10.4%) and mouse (15.8%) plasma because concentrations were substantially lower than ADMA and SDMA. This assay provides unique advantages of small sample volume requirements, excellent separation of target metabolites from contaminants and validation for both human and mouse plasma samples.

Mass spectrometric quantification of L-arginine and its pathway related substances in biofluids: the road to maturity

The amino acid L-arginine together with its metabolites and related substances is in the center of many biologically important pathways, especially the urea cycle and the nitric oxide (NO) synthesis. Therefore, the concentrations of these substances in various biological fluids are of great interest as predictive markers for health and disease. Yet, they provide major analytical difficulties as they are very polar in nature and therefore not easily to be separated on standard reversed phase HPLC stationary phases. Furthermore, as endogenous substances, no analyte-free matrix is available, a fact that results in complicated calibration procedures. This review evaluates the analytical literature for the determination of L-arginine, symmetric dimethylarginine, asymmetric dimethylarginine, monomethylarginine, L-citrulline, L-ornithine, L-homoarginine, agmatine and dimethylguanidinovaleric acid in biological fluids. Papers are discussed, which were published since 2007 and describe methods applying capillary electrophoresis (CE), gas chromatography (GC), reversed phase HPLC or polar phase HPLC, coupled to mass spectrometric quantification. Nowadays, many carefully developed and validated methods for L-arginine and its related substances are available to the scientific community. The use of stable isotope labeled internal standards enables high precision and accuracy in mass spectrometry-based quantitative analysis.

Quantification of arginine and dimethylated arginines in human plasma by field-amplified sample injection capillary electrophoresis UV detection

We report a capillary electrophoresis method by field-amplified sample injection (FASI) for the separation and detection of free plasma arginine and dimethylated arginines. Protein elimination from plasma was performed by acetonitrile/ammonia precipitation. Supernatants were dried, reswollen in water, and directly injected on capillary without complex cleanup by solid-phase extraction and/or tedious sample derivatization procedures. Analytes were baseline-separated within 22 min by using 50 mmol/L Tris phosphate pH 2.3 as running buffer. Due to the stacking effects of electrokinetic injection, it is possible to perform a considerable on-line preconcentration of the analytes before running the electrophoresis. This procedure allows to reach a detection limit in real sample of 10 nmol/L for dimethylated arginines and 20 nmol/L for arginine. Recovery of plasma ADMA was 99-104 % and inter-day CV was less than 3 %.

A new derivatization method coupled with LC-MS/MS to enable baseline separation and quantification of dimethylarginines in human plasma from patients to receive on-pump CABG surgery

Asymmetric dimethylarginine (ADMA) is an inhibitor of nitric oxide synthase and a risk factor for cardiovascular events. We have developed a new derivatization method to enable baseline separation of the regio-isomers, ADMA, and symmetric dimethylarginine (SDMA), within 15 min on a C18 reverse phase column. Reacting naphthalene-2,3-dicarboxaldehyde with ADMA and SDMA in the presence of 2-mercaptoethanol produces corresponding 2,3-dihydro-benzo[f]isoindol-1-ones that are more stable than previously reported ortho-phthaldialdehyde and 2-mercaptoethanol derivatives. LC-MS/MS quantitation of these derivatives can be used to determine ADMA and SDMA concentrations in the plasma of patients to receive on-pump coronary artery bypass grafting (CABG) surgery. The LOD, LOQ and lower LOQ (LLOQ) of this method were determined to be 2.6, 8.7, and 25 nM for ADMA, and 2.5, 8.3, and 25 nM for SDMA, respectively, with consumption of only 50 μL of plasma. The relative standard deviations and relative errors of the intraday and interday determinations, as measurements of reproducibility and accuracy, are all within 15%. The ADMA and SDMA concentrations in patient plasma are 298.1 ± 11.2 nM (mean ± S.E.M., n = 123) and 457.7 ± 19.8 nM (mean ± S.E.M., n = 123), respectively. Upon unblinding of our clinical trial, these predetermined values might explain patient clinical outcomes associated with on-pump CABG surgery, as ADMA is known to inhibit nitric oxide production. Furthermore, this derivatization reaction in conjunction with LC-MS/MS analysis may open a venue to explore alternative chemical labeling modes for LC-MS/MS applications, such as analysis of other amino acids, metabolites, and peptides containing primary amine group(s).

Quantitation of L-arginine and asymmetric dimethylarginine in human plasma by LC-selective ion mode-MS for Type 2 diabetes mellitus study

The article reports a simple, sensitive and fast LC/MS method for the analysis of L-arginine (L-Arg), asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in human plasma. The homoarginine was used as the internal standard (IS). The chromatographic separation was achieved on C₁₈(150 mm×2.1 mm, 5 µm) column with a mobile phase consisting of ammonium acetate (0.25 mmol/l) and methanol (93 : 7, v/v), at a flow rate of 0.2 ml/min. L-Arg, ADMA and SDMA were well separated by LC/MS with selective ion mode (SIM). The method was successfully applied to type 2 diabetes mellitus (T2DM) study. Twenty-one healthy controls and twenty-two T2DM patients before and after treatment two years were investigated. The results indicated that the level of ADMA in T2DM was significantly higher than that in healthy controls. Furthermore, ADMA has important association with the development of cardiovascular diseases.

Simultaneous bioanalysis of L-arginine, L-citrulline, and dimethylarginines by LC-MS/MS

PURPOSE

L-Arginine (ARG) is converted to nitric oxide (NO) and L-citrulline (CIT) by endothelial nitric oxide synthase which is competitively inhibited by asymmetric dimethylarginine (ADMA). We have developed a liquid chromatography-mass spectrometric method for the simultaneous determination of endogenous ARG, labeled ARG (¹⁵N₄-ARG), CIT, ADMA, and its inactive isomer, symmetric dimethylarginine (SDMA) in biological samples.

METHODS

Concentrations of unlabeled ARG, ¹⁵N₄-ARG, CIT, ADMA, and SDMA in EA.hy926 human endothelial cell lysate, cell incubation media, rat plasma or rat urine were measured by hydrophilic-interaction liquid chromatography electrospray tandem mass spectrometry. ¹³C₆-ARG, D₄-CIT and D₇-ADMA were used as internal standards for ARG and ¹⁵N₄-ARG, CIT, and dimethylarginines, respectively.

RESULTS

The calibration curves of ARG, ¹⁵N₄-ARG, CIT, ADMA, and SDMA were linear and independent of several sample matrices. Intra- and inter-day variabilities for the quantification of all the compounds were below 15% in quality control samples. Application of this method to determine the uptake as well as efflux of these compounds was illustrated through in vitro cell study by exposing human endothelial cells to ¹⁵N₄-ARG, which allowed the observation of generation of ¹⁵N₃-CIT and ¹⁵N₃-ARG in the cell lyate. Use of these isotopes adds insights into the cellular handling of endogenous vs. exogenous ARG. Application of this method for rat plasma and rat urine assays was demonstrated after ARG oral supplementation in rats.

CONCLUSION

An LC-MS/MS method was developed to quantify 6 ARG-related compounds simultaneously, utilizing 3 separate internal standards. This assay allows concurrent monitoring of uptake, efflux and metabolic processes when isotope-labeled ARG and CIT are measured, and can be applied for determination of these compounds in rat plasma and rat urine.

Improved method for plasma ADMA, SDMA, and arginine quantification by field-amplified sample injection capillary electrophoresis UV detection

Here, we describe an easy field-amplified sample injection capillary electrophoresis method with UV detection for the separation and detection of free plasma arginine and dimethylated arginines. The analytes were baseline-separated within 22 min by using 50 mmol/L Tris phosphate pH 2.3 as running buffer. The plasma samples were treated with acetonitrile/ammonia for protein elimination, the supernatants were dried, re-swollen in water and directly injected in the capillary without complex cleanup by solid phase extraction and/or tedious sample derivatization procedures. Due to the stacking effects of the electrokinetic injection, it was possible to operate a consistent on-line pre-concentration of the analytes before running the electrophoresis. This procedure allowed to reach a detection limit in the real sample of 10 nmol/L for dimethylated arginines and 20 nmol/L for arginine, thus improving about threefold our previous method, that required a more complicated pre-analytical procedure to concentrate samples. The recovery of plasma ADMA was 99-104% and inter-day CV was less than 3%. The assay performance was evaluated measuring the levels of arginine and its dimethyl derivatives in 50 subjects. The statistical tests for the methods comparison suggest that the data obtained by our new method and by our previous CE assay are similar.

The biochemistry, measurement and current clinical significance of asymmetric dimethylarginine

Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide synthase and an important cause of endothelial dysfunction. Its increased plasma concentration is associated with a variety of traditional cardiovascular risk factors, and may mediate their effects on the vascular endothelium. ADMA is also an independent predictor of cardiovascular events and mortality, and predicts outcomes in critically ill patients in the intensive care unit. This work has provided insights into the role of ADMA as an endogenous regulator of nitric oxide synthesis. At present there is no specific therapy to modify ADMA concentration, but increasing interest and work on protein arginine methyltransferases and dimethylarginine dimethylaminohydrolase, which synthesize and metabolize ADMA, respectively, might provide novel therapeutic targets.

Development and validation of a fast quantitative method for plasma dimethylarginines analysis using liquid chromatography-tandem mass spectrometry

OBJECTIVES

The aim of this work was to implement a fast, accurate and simple method to quantify plasma ADMA and SDMA, in a run time suitable for routine analysis.

DESIGN AND METHODS

We developed and validated a hydrophilic interaction chromatographic method coupled to tandem mass spectrometry (HILIC-MS/MS) for separation and simultaneous quantification of Arginine (Arg) and its dimethylarginines, ADMA and SDMA, with a short run time (less than 5 min) using a small volume of human plasma (0.02 mL).

RESULTS

Correlation coefficients (r) of the calibration curves ranged from 0.9926 to 0.9984. Within-day and between-day imprecision (CV%) and inaccuracy (%), carry-over and recovery were also evaluated for validation. Preliminary data of Arg, ADMA and SDMA from 30 apparently healthy subjects and type 2 diabetic patients (n=33) with and without kidney dysfunction were calculated and some statistical differences occurred among them (p<0.05).

CONCLUSIONS

Data from calibration curves and quality controls reveal that the method is accurate and precise. Healthy subjects and diabetic patients' values are in agreement with those reported in other studies.

Determination of asymmetric dimethylarginine in biological fluids: a paradigm for a successful analytical story

PURPOSE OF REVIEW

To review recently reported analytical methods for the quantification in biological fluids of asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthesis, and to evaluate their impact on clinical research.

RECENT FINDINGS

Recently developed and increasingly used analytical methods in this area are based on mass spectrometry coupled with gas chromatography (i.e., gas chromatography-mass spectrometry and gas chromatography-mass spectrometry/mass spectrometry) or liquid chromatography (i.e., liquid chromatography-mass spectrometry and liquid chromatography-mass spectrometry/mass spectrometry). These approaches revealed asymmetric dimethylarginine concentrations in plasma and serum of healthy adults in the range 400-500 nmol/l. High-performance liquid chromatography methods with fluorescence detection provide asymmetric dimethylarginine plasma/serum concentrations comparable to those of mass spectrometry-based methods. This interval for circulating asymmetric dimethylarginine and the mass spectrometry/mass spectrometry-based methods have the potential to serve as reference values and analytical methods, respectively. An enzyme-linked immunosorbent assay method for asymmetric dimethylarginine has become commercially available and is increasingly used in clinical studies. Comparative studies revealed that the enzyme-linked immunosorbent assay method produces considerably higher asymmetric dimethylarginine concentrations in plasma or serum in healthy humans in the basal state than mass spectrometry and high-performance liquid chromatography methods and runs varyingly in different laboratories.

SUMMARY

At present, many analytical methods allow for the accurate and precise quantification of asymmetric dimethylarginine in biological fluids. However, reliable quantification of biological asymmetric dimethylarginine remains an analytical challenge in basic and clinical research.

High-throughput CZE-UV determination of arginine and dimethylated arginines in human plasma

Experimental studies document that increased asymmetric dimethylarginine (ADMA) blood levels inhibit NOS significantly, reducing NO generation. ADMA measurement often needs sample cleanup by SPE prior to chromatography and precolumn derivatization that cannot be easily employed in a routine clinical setting. We set up a new reliable CE method to measure ADMA, symmetric dimethylarginine (SDMA), and arginine without sample extraction or precolumn derivatization in order to examine their concentrations in human plasma. Sample was concentrated prior to CE injection and analytes were monitored by UV detection. CE analysis was performed in an uncoated fused-silica capillary, 75 microm id and 60.2 cm length (50 cm to the detection window), injecting 1 s water plug (0.5 psi) followed by 10 s of the sample (0.5 psi). Separation was carried out in a 50 mmol/L Tris-phosphate run buffer at pH 2.30, 15 degrees C and 15 kV (75 microA) at normal polarity. Recovery of plasma ADMA was 101-104% and inter-day CV was less than 3%. Assay performance was evaluated measuring the levels of arginine and its dimethyl derivatives in 77 subjects. Passing-Bablok regression and Bland-Altman test for methods comparison suggest that the data obtained by our method and by a reference CE-LIF assay are similar.

Effects of combined supplementation with B vitamins and antioxidants on plasma levels of asymmetric dimethylarginine (ADMA) in subjects with elevated risk for cardiovascular disease

Elevated plasma asymmetric dimethylarginine (ADMA) concentrations have been suggested as a potential risk factor for cardiovascular disease (CVD). Studies indicate a linkage between hyperhomocysteinemia, oxidative stress and ADMA metabolism. We tested the hypothesis that combined supplementation of B vitamins and antioxidants reduces ADMA concentrations in subjects with at least two CVD risk factors. A total of 123 men and women (58+/-8.1 years) were randomly assigned to take either a preparation including B vitamins and antioxidants (verum) or placebo for 6 months in a double-blind design. Blood concentrations of ADMA, symmetric dimethylarginine (SDMA), L-arginine, B vitamins, total homocysteine (tHcy), alpha-tocopherol, antioxidant capacity (TEAC), and oxLDL were measured pre- and post-intervention. Treatment with verum significantly decreased tHcy (-2.14 micromol/L; P<0.001) and significantly increased TEAC values (+39.3 microM; P<0.022), but no effect on ADMA was observed. OxLDL was significantly reduced in verum (-7.3 U/L; P=0.001) and placebo (-9.2U/L; P<0.001). At baseline, significant correlations were found only between ADMA and SDMA (r=0.281; P=0.002), L-arginine/ADMA and SDMA (r=-0.294; P<0.001), L-arginine/ADMA and oxLDL (r=-0.281; P=0.016), and L-arginine/ADMA and age (r=-0.231; P=0.010). Our results indicate that combined supplementation of B vitamins and antioxidants is not an adequate strategy to reduce ADMA plasma levels in subjects with elevated CVD risk.

High-throughput liquid chromatographic-tandem mass spectrometric determination of arginine and dimethylated arginine derivatives in human and mouse plasma

The balance between nitric oxide (NO) and vasoconstrictors like endothelin is essential for vascular tone and endothelial function. L-Arginine is converted to NO and L-citrulline by NO synthase (NOS). Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) are endogenous inhibitors of NO formation. ADMA is degraded by dimethylamino dimethylhydrolases (DDAHs), while SDMA is exclusively eliminated by the kidney. In the present article we report a LC-tandem MS method for the simultaneous determination of arginine, ADMA, and SDMA in plasma. This method is designed for high sample throughput of only 20-mul aliquots of human or mouse plasma. The analysis time is reduced to 1.6 min by LC-tandem MS electrospray ionisation (ESI) in the positive mode. The mean plasma levels of l-arginine, ADMA, and SDMA were 74+/-19 (SD), 0.46+/-0.09, and 0.37+/-0.07 microM in healthy humans (n=85), respectively, and 44+/-14, 0.72+/-0.23, and 0.19+/-0.06 microM in C57BL/6 mice. Also, the molar ratios of arginine to ADMA were different in man and mice, i.e. 166+/-50 and 85+/-22, respectively.

An overview of plasma concentrations of asymmetric dimethylarginine (ADMA) in health and disease and in clinical studies: methodological considerations

Recent studies among patients including those with known coronary disease demonstrate that small elevations in asymmetric dimethylarginine (ADMA) concentrations in plasma are predictive of adverse outcomes. The precision of current methodologies for quantitation of ADMA such as HPLC, MS and ELISA is discussed with respect to many reports which appear to over-estimate ADMA levels and quote broad concentration ranges. While plasma ADMA concentrations tend to increase with age, the mean for a healthy population is between 0.4 and 0.6 microM. ADMA levels may fluctuate in normal subjects, and this needs to be considered in light of the relatively small differences in ADMA concentration between healthy normal subjects and patients.

Chromatographic-mass spectrometric methods for the quantification of L-arginine and its methylated metabolites in biological fluids

L-Arginine (Arg) and its methylated metabolites play a major role in the synthesis of the cell signaling molecule nitric oxide (NO). Arg serves as a substrate for the enzyme NO synthase (NOS), which produces NO, whereas monomethylarginine (L-NMMA) and asymmetric dimethylarginine (ADMA) act as competitive inhibitors of NOS. Symmetric dimethylarginine (SDMA) has virtually no inhibitory effect on NOS activity, but shares the pathway for cell entry and transport with Arg and ADMA. Accurate and reliable quantification of these substances in various biological fluids is essential for scientific research in this field. In this review, chromatographic-mass spectrometric methods for Arg and its methylated metabolites ADMA and SDMA are discussed. Mass spectrometric detection provides an intrinsic higher selectivity than detection by means of UV absorbance or fluorescence. Taking advantage of the high selectivity, approaches involving mass spectrometric detection require less laborious sample preparation and produce reliable results. A consensus emerges that the concentration values in plasma of young healthy volunteers are about 65 microM for Arg, 0.4 microM for ADMA and 0.5 microM for SDMA.

Quantification of ADMA: analytical approaches

Methylated L-arginine analogs are involved in nitric oxide synthase activity regulation. Methods based on high-performance liquid chromatography with fluorescence, capillary electrophoresis, or ion exchange chromatography with absorbance detection were first applied for the quantitative determination of N-monomethyl-L-arginine (NMMA), asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in human blood and urine. These assays revealed elevated circulating levels of ADMA in various diseases and gave accumulating evidence of the usefulness of ADMA as a cardiovascular risk factor. However, the methods used are hampered by the fact that NMMA, ADMA and SDMA can be distinguished from L-arginine only by means of chromatographic separation. This has promoted the development of alternatives that involve mass spectrometry (MS) technology. Today, various MS-based approaches such as liquid chromatography (LC)-MS, LC-MS/MS, gas chromatography (GC)-MS, and GC-MS/MS are available. L-arginine and its analogs have been subjected to LC-MS analysis with and without further derivatization to their o-phthaldialdehyde derivatives. For these methods, labelled L-arginine was used as the internal standard. The first MS-based method that distinguishes NMMA, ADMA, SDMA and L-arginine by mass-to-charge (m/z)-ratio has been reported by Tsikas et al. This GC-MS approach has been further improved by Albsmeier et al by introducing labelled ADMA as an internal standard. As an alternative to existing methods, a commercially available ELISA kit has recently been developed and validated.

Fast and Efficient Determination of Arginine, Symmetric Dimethylarginine, and Asymmetric Dimethylarginine in Biological Fluids by Hydrophilic-Interaction Liquid Chromatography–Electrospray Tandem Mass Spectrometry

Background: Nitric oxide is synthesized from the amino acid Arg by the enzyme endothelial nitric oxide synthase, which is competitively inhibited by the arginine metabolite asymmetric dimethylarginine (ADMA). In this way, increased concentrations of ADMA lead to reduced nitric oxide production associated with a range of cardiac diseases. Research in this field requires the measurement of Arg and of ADMA and its closely related substance, symmetric dimethylarginine (SDMA).

Methods: We quantified Arg, ADMA, and SDMA in human plasma, human urine, and cell culture supernatant by HPLC–electrospray tandem mass spectrometry. Sample preparation required only protein precipitation. Separation was by liquid chromatography on a 150 × 3 mm silica column with an isocratic mobile phase consisting of water–acetonitrile–trifluoroacetic acid–propionic acid (10:90:0.025:1 by volume). The chromatographic run time was 7 min.

Results: The chromatograms were interference-free in all matrices. In the low-concentration quality-control samples, the interassay CVs in plasma were 4.7% for Arg, 7.7% for ADMA, and 4.9% for SDMA. Similar values were obtained in urine and cell culture supernatants. The calibration functions were linear and covered the ranges of healthy and pathologic samples.

Conclusion: The new method requires neither derivatization nor complete chromatographic separation between ADMA and SDMA for quantification of the 3 metabolites, has calibration functions that are independent of the sample matrix, and provides measured concentrations that agree with those reported in the literature.

Measurement of asymmetric dimethylarginine in plasma: methodological considerations and clinical relevance

Asymmetric dimethylarginine (ADMA) is a potent inhibitor of nitric oxide synthase and is regarded as a novel risk factor for cardiovascular disease. The metabolic pathways of ADMA and homocysteine are strongly intertwined. First, during synthesis of ADMA, two equivalents of homocysteine are formed. Second, homocysteine has been shown to inhibit the ADMA-degrading enzyme dimethylarginine dimethylaminohydrolase. Finally, homocysteine, either directly or by increasing oxidative stress, may promote release of free ADMA by accelerating protein degradation. Currently used techniques for the quantification of ADMA in plasma are mostly based on liquid chromatography with fluorimetric or mass spectrometric detection. Plasma ADMA has a very narrow concentration distribution, with an inter-individual coefficient of variation of approximately 12%, and even slightly elevated ADMA concentrations are associated with increased cardiovascular disease risk. Therefore, to generate useful results in clinical research, high precision of the assay used for the quantification of ADMA assay is a matter of prime importance. Assays with a high coefficient of variation may lead to low statistical power in clinical trials and to a severe underestimation of the strength of associations in epidemiological studies.

A new reversed-phase liquid chromatographic/tandem mass spectrometric method for analysis of underivatised amino acids: evaluation for the diagnosis and the management of inherited disorders of amino acid metabolism

Seventy-six compounds of biological interest for the diagnosis of inherited disorders of amino acids (AA) metabolism have previously been demonstrated to be detectable in positive mode electrospray ionisation tandem mass spectrometry (ESI-MS/MS), after separation by ion-pairing reversed-phase liquid chromatography (RPLC). The separation method used tridecafluoroheptanoic acid as ion-pairing agent, and a gradient of acetonitrile for the elution of the most retained compounds. This method had previously been demonstrated to be suitable for the qualitative diagnosis of many AA disorders, and for the quantitative measurement of 16 AA in biological fluids, using their stable isotope labelled (SIL) AA as internal standard. For quantification of the other AA, an internal standard was chosen among the available SIL-AA, as close as possible to the analyte to be measured, in terms of structural analogy, and of retention time in the chromatographic system. The performances of the quantitative analysis of the other AA to be measured are reported here. They show validated results for several AA, allowing their accurate quantification, with another SIL-AA as internal standard. For some other AA, quantitative results were not accurate, allowing only semi-quantitative or qualitative determination for these parameters.