Plasma catecholamines: laboratory aspects

Toxicology update: the cardiotoxicity of the oxidative stress metabolites of catecholamines (aminochromes)

This toxicology update reviews the oxidative stress metabolites of catecholamines, postulated to be the biochemical initiators of cardiotoxicity. A brief overview of catecholamine metabolism is provided with several noteworthy historical observations relating to the autoxidation and rearrangement of epinephrine. The basic chemical and physical properties of adrenochrome and adrenolutin are discussed. The autoxidative, enzymatic and cellular basis for the transformation of catecholamines to oxidative metabolites is reviewed. Mechanisms seeking to account for the observed cardiotoxic changes in isolated heart perfusion studies and in vivo models are described.

Analysis of 9-fluorenylmethyloxycarbonyl derivatives of catecholamines by high performance liquid chromatography, liquid chromatography/mass spectrometry and tandem mass spectrometry

9-Fluorenylmethyloxycarbonyl (FMOC) derivatives of catecholamines, including dopamine (DA; 3,4-dihydroxyphenethylamine), norepinephrine (NE; 2-amino-1-(3,4-dihydroxyphenyl)ethanol) and epinephrine (EPI; 1-phenyl-1-hydroxy-2-methylaminopropane) as well as 3, 4-dihydroxybenzylamine (DHBA) have been analyzed using high performance liquid chromatography coupled to fluorometric detection and atmospheric pressure chemical ionization mass spectrometry at low femtomole levels. Structures of the derivatives have also been characterized by liquid chromatography/atmospheric pressure chemical ionization mass spectrometry and electrospray/tandem mass spectrometry. Protonated molecules of FMOC-DA and FMOC-DHBA as well as [M + H - H(2)O](+) ions of FMOC-NE and FMOC-EPI appear in their conventional mass spectra, and abundant fragments characteristic of catecholamines dominated the spectra. Structurally diagnostic ions using several hundred femtomoles of the FMOC derivatives of catecholamine were observed. Collision-induced dissociation (CID) of electrospray-generated protonated molecules of FMOC-DA and FMOC-DHBA as well as [M + H - H(2)O](+) ions of FMOC-NE and FMOC-EPI produced diagnostic product ion spectra. Liquid chromatography/atmospheric pressure chemical ionization mass spectrometric analysis of the FMOC derivatives of catecholamines and DHBA should prove useful in the separation and characterization of these compounds from biological materials.

Rapid and sensitive determination of catecholamines and the metabolite 3-methoxy-4-hydroxyphen-ethyleneglycol using HPLC following novel extraction procedures

In the present study assays were improved for the determination of free catecholamines and 3-methoxy-4-hydroxyphenethyleneglycol (MHPG), the major metabolite of peripheral and central noradrenaline. The compounds were extracted by a fluid phase extraction: a diphenyl boric acid method for the purification of catecholamines and an ethyl acetate extraction for MHPG were used, respectively. High-performance liquid chromatography with electrochemical detection was employed for quantitative analysis. In previous studies, significant differences between plasma concentrations of these substances in normal volunteers and hospital patients were demonstrated. Therefore, we established valid reference values for a hospital population. Blood and urine samples of 59 patients without disorders and medication affecting catecholamine synthesis and metabolism or the activity of the sympatho-adrenal system were collected and analyzed for free and total (free plus conjugated) MHPG, noradrenaline (NA), adrenaline (A) and dopamine (DA); total MHPG was assayed after enzymatic hydrolysis of conjugates. Our data clearly demonstrate that these methods are sensitive, specific, rapid, and can easily be standardized. The intra- and inter-assay precision were high (CV 2.6-5.3% and 4.3-6.9% for plasma, CV 3.8-4.9% and 5.1-8.2% for urine, respectively). For plasma, the mean concentrations +/- SD were determined to be 20.82+/-4.70 pmol/ml for free MHPG, 68.43+/-16.21 pmol/ml for total MHPG, 2.11+/-0.24 pmol/ml for NA and 0.31+/-0.08 pmol/ml for A. For 24h-urine the mean concentrations +/-SD were determined to be 0.44+/-0.13 mmol/24h for free MHPG, 8.79+/-2.13 mmol/24h for total MHPG, 169.8+/-58.25 nmol/24h for NA, 62.19+/-21.79 nmol/24h for A and 757.2+/-382.6 nmol/24h for DA. In summary, these novel and rapid methods can clearly be employed in a routine clinical setting.

Baroreflex sensitivity and neurohormonal activation in patients with acute myocardial infarction

OBJECTIVE

To examine the relationship between baroreflex sensitivity and neurohormonal activation in patients with an acute myocardial infarction.

METHODS

Baroreflex sensitivity, plasma noradrenaline, atrial natriuretic factor, endothelin-1, and plasma renin activity were measured in 37 male patients about 10 days after their first myocardial infarction, and in 15 healthy controls. Baroreflex sensitivity was assessed from the regression line relating the change in RR interval to the change in systolic blood pressure following an intravenous bolus injection of phenylephrine. The measurements were repeated after a follow up of three months.

RESULTS

There was a significant inverse correlation between baroreflex sensitivity and plasma noradrenaline measured before hospital discharge (r = -0.43, P < 0.01). Patients with increased plasma noradrenaline (> or = 2SD above the mean of the age matched control group) had significantly lower baroreflex sensitivity than patients with normal plasma noradrenaline (8.7 (SD 4.6) v 12.1 (6.1) ms/mm Hg, P < 0.05). The change in baroreflex sensitivity during the follow up showed a significant inverse correlation with the change of plasma noradrenaline (r = -0.450, P < 0.01). Furthermore, when patients with increased plasma noradrenaline before hospital discharge were analysed separately, baroreflex sensitivity at three months in patients in whom plasma noradrenaline had decreased to normal values was significantly higher than in patients in whom plasma noradrenaline had remained increased (14.6 (5.7) v 8.1 (8.1) ms/mm Hg, P < 0.05). On the other hand, baroreflex sensitivity was not related to the levels of plasma atrial natriuretic factor, plasma endothelin-1, or plasma renin activity. Neither was any relationship found between change in baroreflex sensitivity and change in plasma atrial natriuretic factor, endothelin-1, or plasma renin activity during the follow up.

CONCLUSIONS

The impairment baroreflex sensitivity after myocardial infarction was associated with increased concentration of plasma noradrenaline, that is, sympathetic activation, but not with plasma atrial natriuretic factor, endothelin-1, or plasma renin activity. Baroreflex sensitivity provides information about cardiac vagal control as well as about the balance of cardiac sympathetic-parasympathetic regulation.

1,2-Diarylethylenediamines as sensitive pre-column derivatizing reagents for chemiluminescence detection of catecholamines in HPLC

Chemiluminescence detection in high-performance liquid chromatography for derivatives of catecholamines (norepinephrine, epinephrine and dopamine) and isoproterenol was studied on the basis of the peroxyoxalate chemiluminescence reaction. The amines and isoproterenol, derivatized with 1,2-diarylethylenediamines, were separated on a reversed-phase HPLC column (TSK gel ODS-120T) with isocratic elution using a mixture of imidazole buffer (pH 5.8, 120 mM)-methanol-acetonitrile (6:2:9, v/v/v). The eluate was detected by a post-column chemiluminescence reaction system, using bis[4-nitro-2-(3,6,9-trioxadecyloxycarbonyl)phenyl]oxalate and hydrogen peroxide. Of the 141,2-diarylethylenediamines investigated, it was found that 1,2-bis(3-chlorophenyl)ethylenediamine, 1,2-bis(3,4-dichlorophenyl)-ethylenediamine and 1,2-bis(4-chlorophyenyl)ethylenediamine were the most sensitive derivatives for all catecholamines. The derivatization and peroxyoxalate chemiluminescence reaction conditions were optimized for 1,2-bis(3-chlorophenyl)-ethylenediamine. The chromatographic detection limits for catecholamines were approximately 40-120 amol for an injection volume of 100 microliters (signal-to-noise ratio of 3).

Metabolic stress modifies the thermogenic effect of dobutamine in man

OBJECTIVE

To study if metabolic stress modifies the thermogenic effect of dobutamine.

DESIGN

Prospective, increasing dose, pharmacologic study.

SETTING

Laboratory of the Department of Intensive Care Unit at a university hospital.

SUBJECTS

Twelve normal volunteers.

INTERVENTIONS

Dobutamine hydrochloride was infused to 12 healthy male volunteers starting at a dose of 2 micrograms/min/kg and gradually increased to 4 and 6 micrograms/min/kg. Each dose of dobutamine was infused for 20 mins. Metabolic stress was induced in six of the 12 volunteers using a triple hormone infusion (epinephrine, cortisol, and glucagon) before dobutamine, and was continued at a constant rate during the dobutamine infusion. The remaining six volunteers served as the control group and received only dobutamine.

MEASUREMENTS AND MAIN RESULTS

Oxygen consumption (VO2) was measured using a metabolic monitor. Arterial blood pressure was measured noninvasively, and cardiac output was monitored by Doppler echocardiography. Plasma concentrations of dopamine, norepinephrine, and epinephrine were measured in both groups. In the triple hormone group, blood was sampled to measure concentrations of insulin, glucagon, cortisol, free fatty acids, and glycerol to ensure the presence of a metabolic stress reaction. At the maximum dose, dobutamine induced a 19% increase (from 140 +/- 17 to 166 +/- 17 mL/min/m2) in VO2 in the control group and an 11% increase (from 167 +/- 10 to 184 +/- 13 mL/min/m2) in the triple hormone group (p < .05 between the two groups) compared with baseline. No change in the respiratory exchange ratio was seen. The triple hormone infusion alone induced hypermetabolism, a marked hemodynamic response, and increased lipolysis.

CONCLUSIONS

Stress, induced by a triple hormone infusion, diminishes the thermogenic effect of dobutamine. In the clinical setting, a > 10% to 15% increase in VO2 in response to dobutamine may not be explained just by the thermogenic effect of the drug.