A selective and simplified radioimmunoassay of 25-hydroxyvitamin D3

Assessing vitamin D metabolism - four decades of experience

One hundred years ago, the role of vitamin D for bone mineralization and the prevention of rickets was discovered. Vitamin D comprises a group of over 50 metabolites with multiple functions that go far beyond calcium homeostasis and bone mineralization. Approximately 50 years ago, first methods for the measurement of 25-hydroxyvitamin D (25(OH)D) in human blood were developed. Over the years, different analytical principals were employed including competitive protein binding assays, high-performance liquid chromatography, various immunoassay and mass spectrometric formats. Until the recent standardization of serum 25(OH)D measurement, agreement between methods was unsatisfactory. Since then, comparability has improved, but substantial variability between methods remains. With the advent of liquid chromatography tandem mass spectrometry (LC-MS/MS), the accurate determination of 25(OH)D and other metabolites, such as 24,25(OH)2D, becomes increasingly accessible for clinical laboratories. Easy access to 25(OH)D testing has triggered extensive clinical research showing that large parts of the population are vitamin D deficient. The variable response of vitamin D deficient individuals to supplementation indicates that assessing patients' vitamin D stores by measuring 25(OH)D provides limited insight into the metabolic situation. Meanwhile, first evidence has emerged suggesting that the simultaneous measurement of 25(OH)D, 24,25(OH)2D and other metabolites allows a dynamic evaluation of patients' vitamin D status on metabolic principals. This may help to identify patients with functional vitamin D deficiency from those without. It can be expected that research into the assessment vitamin D status will continue for another 50 years and that this will help rationalizing our approach in clinical practice.

Measurement of circulating 25-hydroxyvitamin D: A historical review

The constantly increasing requests for the measurement of serum 25-hydroxyvitamin D over the last years has led reagent manufacturers to market different automated and semi-automated methods, that being unfortunately not fully harmonized, yield different results. Liquid chromatography coupled to tandem mass spectrometry (LC/MS2) has more recently been introduced. This approach allows the distinction between the two forms of 25-hydroxyvitamin D and to measure other metabolites. This approach also requires harmonization to curtail the differences between the different analytical methods. To meet this requirement, the American National Institutes of Health (NIH), the Centre for Disease Control and Prevention (CDC) in Atlanta, the National Institute of Standards and Technology (NIST) and the vitamin D Reference laboratory of Ghent University have pooled their expertise to develop a standardization program. This article reviews the main elements and the difficulties of the automated and semi-automated methods for 25-hydroxyvitamin D, from sample preparation to the analytical phase, as well as those related to mass spectrometry. It also emphasizes the need for standardization to better define the clinical decision thresholds of vitamin D nutritional status.

The relationship between vitamin D levels and saphenous vein graft patency

OBJECTIVE

A growing body of evidence supports an association between vitamin D and cardiovascular diseases. Coronary artery bypass grafting surgery is a treatment modality for suitable patients with coronary artery disease; however, patency rates of saphenous vein grafts (SVGs) are low. In this study we aimed to determine the association between vitamin D levels and the SVG disease.

METHODS

The study population included 180 patients who had undergone a primary coronary artery bypass grafting surgery with at least one SVG and later had a control angiography because of clinical indications. Patients were divided into two groups: 100 patients with SVG disease and 80 of them with patent SVG.

RESULTS

The mean age of 180 patients was 57.4±8.8 years, and 64.4% of the study population were men. The total number of SVGs was 364, and the mean number of SVGs to each patient was 2.02±0.61. Vitamin D levels were higher in the patent SVG group than in the SVG disease group (36.2±10.7 and 21.1±10.4, respectively; P<0.001). C-reactive protein levels were significantly higher in the SVG disease group (8.3 vs. 6.5 mg/dl, P=0.001). In a multivariate regression analysis, current smoking, diabetes mellitus, target artery diameter less than 1.5 mm, bypass time duration, and vitamin D levels remained as independent factors associated with SVG disease.

CONCLUSION

Lower vitamin D levels are associated with occlusion of SVGs in patients with coronary artery disease.

Determination of vitamin D and its metabolites

The demand for analysis of 25-hydroxyvitamin D has increased dramatically throughout the world over the past decade. As a consequence, a number of new automated assays have been introduced for 25-hydroxyvitamin D measurement. Automated assays have shown variable ability to meet the technical challenges associated with 25-hydroxyvitamin D measurement. Assays are able to meet performance goals for precision at high concentrations but fail to do so at low concentrations of 25-hydroxyvitamin D. The overall accuracy of automated methods has improved over recent years and generally shows good overall agreement with reference methods; however, discrepancies persist for individual samples. Liquid chromatography-tandem mass spectrometry is used by some routine laboratories for 25-hydroxyvitamin D analysis but its widespread use is hampered by limited sample throughput. 1,25-Dihydroxyvitamin D is an important analyte in specific clinical situations, which remains in the hands of specialised laboratories using manual analytical methods.

Selective monitoring of vitamin D2 and D3 supplementation with a highly specific 25-hydroxyvitamin D3 immunoassay with negligible cross-reactivity to 25-hydroxyvitamin D2

BACKGROUND

The effects of vitamin D2 and D3 supplementation on circulating concentrations of 25(OH)D3 require reliable analytical tools for specific determination of 25(OH)D3 and 25(OH)D2. We have developed a highly specific 25-OH Vitamin D3 ELISA with negligible cross-reactivity towards 25(OH)D2.

METHODS

25(OH)D3 concentrations were measured in several study participants; 1) 641 healthy men and women; 2) 39 postmenopausal women receiving 400-800 IU vitamin D3 daily for 4 months; 3) 45 men and women with hip fracture receiving 1000 IU vitamin D2 daily for 3 months.

RESULTS

This 25-OH Vitamin D3 ELISA had minimal cross-reactivity to 25(OH)D2, (0.7%), and demonstrated a high correlation (r2 = 0.93) with 25(OH)D3 determined by HPLC. 25(OH)D3 increased by 14% in subjects receiving vitamin D3 for 4 months (p < 0.01), whereas there was no significant change in 25(OH)D3 levels in those receiving vitamin D2.

CONCLUSIONS

We report that 25(OH)D3 ELISA was used for evaluation of 25(OH)D3 concentrations in subjects receiving vitamin D2 and D3 supplementation. The increase of 25(OH)D3 in circulation with vitamin D3 supplementation and lack of increase with vitamin D2 supplementation suggest that this assay has sufficient sensitivity and specificity to be used as a reliable measurement of nutritional vitamin D3 status in humans.

Rapid and sensitive high-performance liquid chromatographic method for simultaneous determination of retinol, alpha-tocopherol, 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 in human plasma with photodiode-array ultraviolet detection

A new rapid and sensitive high-performance liquid chromatographic method using 0.5 ml of plasma has been developed for the simultaneous determination of retinol (vitamin A), alpha-tocopherol (vitamin E), 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3. The eluate was monitored with a photodiode-array detector with two fixed wavelengths (267 nm for vitamin D, 292 nm for alpha-tocopherol and retinol). For all compounds, including internal standards, the method provides extraction recoveries greater than 81%. Detection limits were equal to or lower than 1.5 microg/l for the 4 vitamins. Linearity of standards was excellent (r>0.999 in all cases). Intra-day and inter-day precision were generally acceptable; the intra-dayassay C.V. was 3/4 7.7 for all compounds and the inter-day-assay C.V. was <9.2% except for the lower concentrations of 25-hydroxyvitamin D3, 25-hydroxyvitamin D2 and alpha-tocopherol (10.8, 11.8 and 11.9, respectively). The important properties of the present method are its ease of use, its rapidity, since sample preparation was achieved in 15 min and all the compounds were eluted in less than 15 min, and its small sample volume required (=0.5 ml), which enables it to be used in pediatric practice.

Determination of vitamin D3 metabolites: state-of-the-art and trends

The steps involved in the methods for the determination of vitamin D3 metabolites (namely, 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, 24,25-dihydroxyvitamin D3) mainly in clinical samples are critically reviewed. Sample pretreatment (e.g. deproteinization, saponification, liquid liquid and liquid solid extraction, etc.) as a function of both type of sample and detection system, quantitation based on protein saturation and liquid as well as gas chromatography are discussed. The chemical principles on which the methods are based and the derivatization procedures, which facilitate separation and/or detection, are also commented upon. Finally, the future prospects of the research on methods for the determination of these metabolites are outlined.

Enzyme immunoassay for measuring 25-hydroxyvitamin D3 in serum

We developed a rapid, competitive enzyme immunoassay (EIA) for measuring 25-hydroxyvitamin D3 [25(OH)D3] in serum. The EIA was based upon 25(OH)D3-3-hemisuccinate covalently coupled to secondary amino groups grafted onto the polystyrene surface of microtiter wells. Optimal coupling conditions were established, and we found that inclusion of 40 μmol/L chloramine T, an agent not previously described for use in coupling to these plates, resulted in both more reproducible coupling as well as more than a twofold increase in the coupling efficiency. Before EIA, 25(OH)D3 was extracted from the serum samples by acetonitrile, and the redissolved extract was incubated with polyclonal rabbit antibody raised against 1,25-dihydroxyvitamin D3-3-hemisuccinate conjugated to bovine serum albumin. Peroxidase-labeled antibody raised in goat against rabbit immunoglobulins was used for detection. The detection limit of the EIA was 4.4 μg/L; recovery 102%; on-plate CV 11%; within-run CV including extraction 12%, and between-run CV 15%. There was no clinically important cross-reactivity with other vitamin D metabolites, and results obtained by the EIA were compared with results obtained by a previously described RIA.

Enzyme immunoassay for plasma 25-hydroxyvitamin D3 employing immunoaffinity chromatography as a pretreatment method

An enzyme immunoassay (EIA) of 25-hydroxyvitamin D3 [25(OH)D3] has been developed as a new methodology for measuring its plasma levels. Three anti-25(OH)D3 antibodies elicited against 25(OH)D3 3-hemisuccinate or -hemiglutarate conjugated with bovine serum albumin were used for this purpose. Two enzyme-labeled antigens were prepared by linking these haptens to beta-galactosidase employing the N-succinimidyl ester method. An EIA system, selected from several combinations of the antibodies and labeled antigens, exhibited higher sensitivity and specificity than those of the conventional competitive protein binding assay. However, direct measurement of plasma specimens gave lower values than those obtained from the ones which were pretreated with a Sephadex LH-20 column followed by a normal-phase high-performance liquid chromatography. This problem has been overcome by employing immunoaffinity chromatography (IAC). In IAC the homologous anti-25(OH)D3 antibody with that used in the EIA was immobilized as a pretreatment method. The IAC/EIA system developed in this study afforded reliable plasma 25(OH)D3 levels which were confirmed by serial dilution study and the recovery test. The 25(OH)D3 levels of healthy volunteers in the summer measured by this method were 25.2 +/- 6.2 ng/ml (n = 10).

Production and specificity of antisera raised against 25-hydroxyvitamin D3-[C-3]-bovine serum albumin conjugates

In order to obtain specific antisera for use in the enzyme immunoassay of 25-hydroxyvitamin D3, three hapten-carrier conjugates having different lengths of bridges at the C-3 position were prepared from 25-hydroxyvitamin D3 by coupling with bovine serum albumin using the active ester method. The specificity of anti-25-hydroxyvitamin D3 antisera elicited in rabbits was tested by a cross-reaction study with closely related secosterols and by measuring the plasma levels of 25-hydroxyvitamin D3 by means of radioimmunoassay using tritium-labeled antigen. The results indicated that the specificity of the antisera obtained is higher than that of vitamin D-binding protein, and that some of these antisera are suitable for enzyme immunoassay.

A simplified high-performance liquid chromatographic method for determination of vitamin D3, 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 in human serum

Measurement of the serum level of 25-hydroxyvitamin D is the most useful parameter in evaluating vitamin D status. The serum level of vitamin D is a useful parameter in studying short time effects after exposure to ultraviolet light and absorption of the vitamin after oral administration. A method for simultaneous determinations of vitamin D3 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 is described. Serum or plasma was extracted by methanol-isopropanol (90:10, v/v) and hexane. The hexane layer was injected in to a reversed-phase (C18) high-performance liquid chromatographic (HPLC) system. 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 were eluted by methanol-water (85:15, v/v), and vitamin D3 by a linear gradient of methanol-water (85:15) and methanol-isopropanol-water (87.5:10:2.5), and detected by u.v. absorption. This method gave separate determinations of the D2 and D3 forms of 25-hydroxyvitamin D, but owing to an interfering peak the method does not measure vitamin D2. The assay was very sensitive with a detection limit of 5 nmol l-1 for 25-hydroxyvitamin D2 and D3 and vitamin D3 by using 0.5 ml serum or plasma for analysis, so that for low vitamin D3 levels more than 1 ml of serum is desirable.

Rickets in Nigerian children: a consequence of calcium malnutrition

Eleven Nigerian children with clinically and radiologically proven rickets were assessed biochemically. The children had low or low normal concentrations of total and corrected calcium, and elevated plasma alkaline phosphatase (ALP) activity, but normal plasma phosphate concentrations. Their serum 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-(OH)2D) concentrations were not significantly different from those in controls, but the ratio of 1,25-(OH)2D to 25-OHD was significantly greater than that in controls. Parathyroid hormone (PTH) concentrations were greater in rachitic children, and there was a significant correlation between 1,25-(OH)2D and PTH concentrations. Osteocalcin concentrations in rachitic children were not significantly different from those in controls, but they were markedly elevated in the three patients with the highest 1,25-(OH)2D and PTH concentrations. One child, from whom a sample of bone (from a corrective osteotomy) was available for histological examination, showed markedly thickened osteoid seams, characteristic of rickets. All the rachitic children had a calcium intake of less than 150 mg daily. Treatment of these rachitic children with calcium gluconate (1 g/d) led to clinical, radiological, and biochemical healing of rickets. We conclude that rickets in Nigerian children is not due to vitamin D deficiency, but to a lack of calcium. This observation has implications regarding the pathogenesis, treatment, and prevention of rickets/osteomalacia in Nigeria and possibly other African and tropical countries.

Vitamin D3 and cardiovascular function in rats

We have previously identified a receptor for 1,25-dihydroxyvitamin D3 in myocardial cells (Simpson, R.U. 1983. Circulation. 68:239.). To establish the relevance of this observation, we evaluated the role of the prohormone vitamin D3 in regulating cardiovascular function. In rats maintained on a vitamin D3-deficient diet for nine weeks, increases in systolic blood pressure (BP) and serum creatine phosphokinase (CPK) were observed. These increases coincided with a reduction of serum calcium from 10.3 to 5.6 mg/dl. However, while serum calcium remained depressed throughout the study, increases in BP and serum CPK were transient. After nine weeks of vitamin D3-depletion, but not after six weeks, ventricular and vascular muscle contractile function were also markedly enhanced. The increase in ventricular contractile function could not be prevented by maintaining serum calcium at 9.0 mg/dl during the period of D3-depletion. These observations suggest a primary role for the vitamin D3-endocrine system in regulating cardiovascular function.

Serum concentration of vitamin D metabolites in rheumatoid arthritis

One-hundred and two patients with rheumatoid arthritis (RA) were studied. They were divided into three groups according to treatment with gold salts, penicillamine or glucocorticoids. Blood samples were drawn between November and January and four different metabolites of vitamin D (25(OH)D3, 24,25 (OH)2D3, 25,26 (OH)2D and 1,25 (OH)2D) were measured and compared to values from normal subjects. The mean serum concentrations of 25(OH)D3 in all three patient groups were significantly lower than those of the controls (p less than 0.01-0.001). The mean serum concentrations of 24,25 (OH)2D3 and 25,26 (OH)2D were not significantly different from the control values, whereas 1,25 (OH)2D concentrations were significantly lower in the penicillamine and steroid groups (p less than 0.05-0.01). When patients were stratified according to functional classes, we found a significant inverse relation between serum concentrations of 25(OH) D3, 24,25(OH)2D3, 25,26(OH)2D and the functional class, but not between 1,25(OH)2D and the functional class. We conclude that the decreased serum 25(OH)D3 concentration found in patients with RA is likely to be caused by decreased exposure to sunlight due to decreased activity, and thus is a result of the disease rather than a pathogenetic factor. Whether the small decrease in serum 1,25(OH)2D is of clinical significance and related to the development of osteoporosis in patients with RA is probably doubtful.

Serum vitamin D metabolites are not related to growth rate, bone mineral content, or serum alkaline phosphatase in male puberty

Twenty boys were followed during their puberty for about 2 years with examinations every third month. At each examination we determined serum concentrations of 25OHD3, 1,25(OH)2D3, 24,25(OH)2D3, 25.26(OH)2D3, alkaline phosphatase (AP) and testosterone together with bone mineral content (BMC) at the distal forearm. Highly significant increases in both BMC (P less than 0.001), serum AP (P less than 0.001), and peak height velocity (PHV) followed the increase in serum testosterone. The boys were grouped according to time of maximal increase in BMC, AP, and PHV. The serum levels of the vitamin D metabolites were related to these points. No significant changes in any of the serum vitamin D metabolites were found. Thus vitamin D metabolism does not seem to be significantly influenced during the period of life when both the linear growth and bone mineralization is maximal.

Different metabolism of vitamin D2/D3 in epileptic patients treated with phenobarbitone/phenytoin

Serum concentrations of vitamin D metabolites were measured before and during treatment with either vitamin D2 or vitamin D3, 4000 IU per day for 24 weeks, in 22 epileptic outpatients receiving phenobarbitone/phenytoin. The serum concentration of total 1,25(OH)2D did not change during the treatment period in any of the treatment groups. On the other hand, in the vitamin D2 group, serum 25(OH)D2, total 25(OH)D, and 24,25(OH)2D increased significantly during the trial, whereas serum concentrations of the vitamin D3 metabolites were unchanged. In the vitamin D3 group, serum concentrations of the vitamin D3 metabolites increased significantly, whereas the vitamin D3 metabolite levels remained unchanged. However, vitamin D3 treatment resulted in a 2-4-fold greater increase in serum concentrations compared to vitamin D2 treatment. Treatment with vitamin D2 and vitamin D3 in the same dose in IU results in considerably different serum concentrations of the vitamin D metabolites.

Discrepancy between serum 1,25-dihydroxycholecalciferol measured by radioimmunoassay and cytosol radioreceptor assay

A radioimmunoassay for determination of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) in serum, was compared with the radioreceptor assay using cytosol receptor from rachitic chick intestine in order to clarify whether differences in specificity can explain discrepancies in the clinical application of the two techniques. In the literature, seasonal fluctuations in serum 1,25(OH)2D3 are only observed when using radioimmunoassay. Treatment of anticonvulsant osteomalacia with vitamin D3 results in a marked increase in radioimmunologically measured 1,25(OH)2D3, but no effect on the serum 1,25(OH)2D level, measured by the radioreceptor assay, could be observed. The present study demonstrates that another unknown compound is coeluted on high pressure liquid chromatography with 1,25(OH)2D3, and recognised only by the antiserum. It can be concluded that the present radioimmunoassay cannot replace the cytosol receptor assay or either supplement by measuring the 1,25(OH)2D3 metabolite only.

Different metabolism of vitamin D2 and vitamin D3 in epileptic patients on carbamazepine

Serum concentrations of vitamin D metabolites were measured in 30 epileptic outpatients on monotherapy with carbamazepine before and during treatment with either vitamin D2 or vitamin D3, 4000 IU per day for 24 weeks. Vitamin D2 treatment increased the serum concentration of 25OHD2, but a corresponding decrease in 25OHD3 resulted in an unchanged serum value of total 25OHD. Vitamin D3 treatment increased the serum concentration of 25OHD3. The resulting serum level of 25OHD was consequently twice the level of that in the D2-treated group. The serum concentrations of the dihydroxy metabolites showed a similar difference between the 2 treatment groups. We conclude that treatment with vitamins D2 and D3 in the same doses produces considerably different serum concentrations of vitamin D metabolites. If the present findings can be extrapolated to normal subjects, it is important to consider more carefully which D-vitamin should be used, both with regard to therapy and supplementation.

Measurement of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 in clinical settings

A quick and simple method for the selective measurement of 25-hydroxyvitamin D3 (25OHD3) and 25-hydroxyvitamin D2 (25OHD2) is described. It includes a rapid sample preparation technique and a combination of a selective radioimmunoassay for 25OHD3 and a competitive protein-binding assay using vitamin D-binding protein for the determination of total 25OHD, including 25OHD3 and 25OHD2. The method was compared with a procedure which include methanol/methylene chloride extraction and chromatography on Sephadex LH 20, and a procedure which includes HPLC and final quantification by u. v. detection. The methods were applied to three groups of patients in order to obtain information on how far assay procedures could be simplified for use in the clinical settings. It is concluded that the method described is applicable for following patients on vitamin D2 therapy. When groups of patients have to be compared, the mean values of the estimates are comparable, whether a simple method or a laborious method is used. Hence, the selection of assay method should take into account the clinical problem and the cost of the analysis.

A sensitive and selective radioimmunoassay for serum 24,25-dihydroxycholecalciferol in man

We have developed a sensitive and selective radioimmunoassay for 24,25-dihydroxycholecalciferol (24,25(OH)2D3). Antisera with a high titre and affinity to 24,25(OH)2D3 were raised in rabbits immunized with a protein conjugate of the 3-hemisuccinate derivative of 24,25(OH)2D3. Serum samples were extracted by methanol/dichloromethane and the lipid extracts purified on Sephadex LH 20 and chromatographed by single step HPLC on a straight phase silica column. The radioimmunoassay is capable of measuring 24,25(OH)2D3 in the '24,25(OH)2D complex' isolated by HPLC and containing the comigrating metabolites: 24,25(OH)2D3, 24,25(OH)2D2, 25(OH)D3-26,23 lactone and 25,26(OH)2D2. The detection limit of 2 pg/assay tube is a marked improvement, compared to the competitive protein binding assay using rachitic rat serum. Measured by the radioimmunoassay 24,25(OH)2D3 ranged from 0.05 to 1.96 ng/ml with a mean of 0.85 ng/ml in 34 healthy adults. For comparison 24,25(OH)2D, measured simultaneously by competitive protein binding with rachitic rat serum, ranged from 0.1 to 4.0 ng/ml with a mean of 1.76 ng/ml.