US20140353486A1 - Methods for determining total body skeletal muscle mass - Google Patents

Methods for determining total body skeletal muscle mass Download PDF

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US20140353486A1
US20140353486A1 US14/363,779 US201214363779A US2014353486A1 US 20140353486 A1 US20140353486 A1 US 20140353486A1 US 201214363779 A US201214363779 A US 201214363779A US 2014353486 A1 US2014353486 A1 US 2014353486A1
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creatinine
creatine
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biological sample
concentration
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Michael S. Leonard
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University of California
GlaxoSmithKline LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4869—Determining body composition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/0045—Devices for taking samples of body liquids
    • A61B10/007—Devices for taking samples of body liquids for taking urine samples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/15—Devices for taking samples of blood
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4519—Muscles
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N30/00—Investigating or analysing materials by separation into components using adsorption, absorption or similar phenomena or using ion-exchange, e.g. chromatography or field flow fractionation
    • G01N30/02—Column chromatography
    • G01N30/62—Detectors specially adapted therefor
    • G01N30/72—Mass spectrometers
    • G01N30/7233—Mass spectrometers interfaced to liquid or supercritical fluid chromatograph
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/70—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving creatine or creatinine
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01J—ELECTRIC DISCHARGE TUBES OR DISCHARGE LAMPS
    • H01J49/00—Particle spectrometers or separator tubes
    • H01J49/0027—Methods for using particle spectrometers
    • H01J49/0036—Step by step routines describing the handling of the data generated during a measurement
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01J—ELECTRIC DISCHARGE TUBES OR DISCHARGE LAMPS
    • H01J49/00—Particle spectrometers or separator tubes
    • H01J49/004—Combinations of spectrometers, tandem spectrometers, e.g. MS/MS, MSn
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/483—Physical analysis of biological material
    • G01N33/487—Physical analysis of biological material of liquid biological material
    • G01N33/493—Physical analysis of biological material of liquid biological material urine

Definitions

  • This invention relates to methods for determining the total body pool size of creatine and total body skeletal muscle mass in a subject by the use of an orally administered tracer dose of D3-creatine, and encompasses improved methods for determining the concentration of creatinine in a biological sample.
  • Skeletal muscle plays a central role in metabolic adaptations to increasing and decreasing physical activity, in disease (e.g. cachexia), in obesity, and in aging (e.g. sarcopenia).
  • Sarcopenia is described as the age-associated loss of skeletal muscle (Evans (1995) J. Gerontol. 50A:5-8) and has been associated with mobility disability (Janssen and Ross, (2005) J. Nutr. Health Aging 9:408-19) and greatly increased health-care costs for elderly people (Janssen et al. (2004) J. Am. Geriatr. Soc. 52:80-5).
  • Loss of skeletal muscle with advancing age is associated with decreased energy requirements and concomitant increase in body fatness, weakness and disability, insulin resistance and risk of diabetes.
  • Loss of skeletal muscle associated with an underlying illness is associated with a greatly increased mortality (Evans (2008) Clin. Nutr. 27:793-9).
  • the present invention is based on the finding that steady-state enrichment of D3-creatinine in a urine sample following oral administration of a single defined tracer dose of D3-creatine can be used to calculate total-body creatine pool size and skeletal muscle mass in a subject.
  • the invention is further based on the finding that the concentration of creatinine in a biological sample can be determined by measuring the concentration of creatinine M+2 isotope and dividing this concentration by a dilution factor, where the dilution factor is the ratio of the concentration of creatinine M+2 to the concentration of creatinine M+0 in the biological sample. Determining the creatinine concentration in a biological sample according to these improved methods allows for the simultaneous measurement of the concentration of creatinine and D3-creatinine in a single sample using widely-available instrumentation. Accordingly, this improved detection method will facilitate the wide-spread adaptation of the present methods for use in determining skeletal muscle mass in patients.
  • the invention provides a method for determining the total body skeletal muscle mass in a subject, where the method comprises the steps of:
  • the biological sample is a urine sample.
  • the concentration of creatinine and D3-creatinine in the urine sample is determined by HPLC/MS/MS.
  • the invention provides a method of determining the concentration of creatinine in a biological sample from a subject, said method comprising the steps of:
  • FIG. 1 Urinary D3-creatinine enrichment and total body creatine pool size in growing rats.
  • B Creatine pool size calculated from 72 h urinary D3-creatinine enrichments for the rat groups in FIG. 1 , showing clear separation of age groups (p ⁇ 0.0001).
  • FIG. 3 Even within the rat groups of different age from FIG. 1 , there is a significant correlation of creatine pool size and lean body mass by either quantitative magnetic resonance (left) or DEXA (right).
  • FIG. 6 This figure shows a flow chart for one embodiment of the method of determining total body skeletal mass.
  • the present invention is based on the finding that enrichment of D3-creatinine in a urine sample following oral administration of a single defined dose of D3-creatine can be used to calculate total-body creatine pool size and skeletal muscle mass in a subject. Accordingly, the invention provides a non-invasive, accurate method of determining total body skeletal muscle. The methods of the invention find use, inter alia, in diagnosing and monitoring medical conditions associated with changes in total body skeletal muscle mass, and in screening potential therapeutic agents to determine their effects on muscle mass.
  • D3-creatine is orally administered to a subject.
  • the present is not limited by mechanism, it is believed that the D3-creatine is rapidly absorbed, distributed, and actively transported into skeletal muscle, where it is diluted in the skeletal muscle pool of creatine.
  • Skeletal muscle contains the vast majority (>than 98%) of total-body creatine.
  • creatine is converted to creatinine by an irreversible, non-enzymatic reaction at a stable rate of about 1.7% per day.
  • This creatinine is a stable metabolite that rapidly diffuses from muscle, is not a substrate for the creatine transporter and cannot be transported back into muscle, and is excreted in urine.
  • the enrichment of a D3-creatinine in spot urine sample after a defined oral tracer dose of a D3 creatine reflects muscle creatine enrichment and can be used to directly determine creatine pool size. Skeletal muscle mass can then be calculated based on known muscle creatine content.
  • the invention provides a method of determining the total body skeletal muscle mass in a subject, where the method comprises the steps of:
  • a hydrate of D3-creatine is administered to the subject.
  • D3-creatine monohydrate is administered.
  • the dose of D3-creatine to be administered to the subject is preferably selected such that the labeled creatine is rapidly absorbed into the bloodstream and spillage of excess label into the urine is minimized.
  • the dose of D3-creatine is typically 5-250 mgs, such as 20-125 mgs.
  • 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100 mgs of D3-creatine is administered.
  • the dose is adjusted based on the gender of the subject.
  • the subject is female and 10-50, such as 20-40, or more particularly, 30 mg of D3-creatine is administered to the subject.
  • the subject is male and 40-80 mg, such as 50-70, or more particularly, 60 mg or 70 mg of D3-creatine is administered to the subject.
  • compositions adapted for oral administration may be presented as discrete units such as capsules or tablets; powders or granules; solutions or suspensions, each with aqueous or non-aqueous liquids; edible foams or whips; or oil-in-water liquid emulsions or water-in-oil liquid emulsions.
  • the active drug component may be combined with an oral, non-toxic pharmaceutically acceptable inert carrier such as ethanol, glycerol, water, and the like.
  • powders are prepared by comminuting the compound to a suitable fine size and mixing with an appropriate pharmaceutical carrier such as an edible carbohydrate, as, for example, starch or mannitol. Flavorings, preservatives, dispersing agents, and coloring agents may also be present.
  • Capsules can be made by preparing a powder, liquid, or suspension mixture and encapsulating with gelatin or some other appropriate shell material.
  • Glidants and lubricants such as colloidal silica, talc, magnesium stearate, calcium stearate, or solid polyethylene glycol may be added to the mixture before the encapsulation.
  • a disintegrating or solubilizing agent such as agar-agar, calcium carbonate or sodium carbonate may also be added to improve the availability of the medicament when the capsule is ingested.
  • suitable binders, lubricants, disintegrating agents, and coloring agents may also be incorporated into the mixture.
  • binders examples include starch, gelatin, natural sugars such as glucose or beta-lactose, corn sweeteners, natural and synthetic gums such as acacia, tragacanth, or sodium alginate, carboxymethylcellulose, polyethylene glycol, waxes, and the like.
  • Lubricants useful in these dosage forms include, for example, sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride, and the like.
  • Disintegrators include, without limitation, starch, methyl cellulose, agar, bentonite, xanthan gum, and the like.
  • Tablets can be formulated, for example, by preparing a powder mixture, granulating or slugging, adding a lubricant and disintegrant, and pressing into tablets.
  • a powder mixture may be prepared by mixing the compound, suitably comminuted, with a diluent or base as described above.
  • Optional ingredients include binders such as carboxymethylcellulose, aliginates, gelatins, or polyvinyl pyrrolidone, solution retardants such as paraffin, resorption accelerators such as a quaternary salt, and/or absorption agents such as bentonite, kaolin, or dicalcium phosphate.
  • the powder mixture may be wet-granulated with a binder such as syrup, starch paste, acadia mucilage or solutions of cellulosic or polymeric materials, and forcing through a screen.
  • a binder such as syrup, starch paste, acadia mucilage or solutions of cellulosic or polymeric materials
  • the powder mixture may be run through the tablet machine and the result is imperfectly formed slugs broken into granules.
  • the granules may be lubricated to prevent sticking to the tablet forming dies by means of the addition of stearic acid, a stearate salt, talc or mineral oil.
  • the lubricated mixture is then compressed into tablets.
  • the compounds of the present invention may also be combined with a free flowing inert carrier and compressed into tablets directly without going through the granulating or slugging steps.
  • a clear or opaque protective coating consisting of a sealing coat of shellac, a coating of sugar or polymeric material, and
  • Oral fluids such as solutions, syrups, and elixirs may be prepared in dosage unit form so that a given quantity contains a predetermined amount of the compound.
  • Syrups may be prepared, for example, by dissolving the compound in a suitably flavored aqueous solution, while elixirs are prepared through the use of a non-toxic alcoholic vehicle.
  • Suspensions may be formulated generally by dispersing the compound in a non-toxic vehicle.
  • Solubilizers and emulsifiers such as ethoxylated isostearyl alcohols and polyoxy ethylene sorbitol ethers may be added.
  • Solubilizers that may be used according to the present invention include Cremophor EL, vitamin E, PEG, and Solutol.
  • Preservatives and/or flavor additives such as peppermint oil, or natural sweeteners, saccharin, or other artificial sweeteners; and the like may also be added.
  • the urine sample in preferably collected after enrichment levels of D3-creatinine in the urine have reached a steady-state.
  • at least 6 hours or at least 12 hours is allowed to elapse after the administration of the D3-creatine but prior to the collection of the urine sample.
  • at least 24 hours is allowed to elapse.
  • at least 36 hours, at least 48 hours, at least 60 hours, or at least 72 hours are allowed to elapse after the administration of the D3-creatine and before the collection of the urine sample.
  • the invention also encompasses certain improved analytic methods for detecting creatinine and D3-creatinine in urine samples.
  • the invention provides for the detection of creatinine and D3-creatinine in urine samples by HPLC/MS, particularly HPLC/MS/MS.
  • HPLC/MS particularly HPLC/MS/MS.
  • alternate methods know in the art may also be used to detect creatinine and/or D3 creatinine in urine samples. Such methods include direct or indirect colorimetric measurements, the Jaffe method, enzymatic degradation analysis, or derivatization of the creatinine followed by GC/MS analysis of HPLC with fluorescence detection.
  • the invention provides a method of determining the concentration of creatinine in a biological sample from a subject, said method comprising the steps of:
  • the biological sample may be any appropriate sample including, but not limited to, urine, blood, serum, plasma, or tissue.
  • the biological sample is a urine sample.
  • the biological sample is a blood sample.
  • the peak area of the creatinine M+2 isotope peak is determined using liquid chromatography/mass spectroscopy (LC/MS/MS).
  • the dilution factor is 0.0002142 ⁇ 0.0000214. More particularly, the dilution factor is 0.0002142 ⁇ 0.00001, such as 0.0002142 ⁇ 0.000005.
  • the methods of the invention are useful for diagnosing and monitoring medical conditions associated with changes in total body skeletal muscle mass.
  • medical conditions in which loss of muscle mass plays an important role in function, performance status, or survival include, but are not limited to frailty and sarcopenia in the elderly; cachexia (e.g., associated with cancer, chronic obstructive pulmonary disease (COPD), heart failure, HIV-infection, tuberculosis, end stage renal disease (ESRD); muscle wasting associated with HIV therapy, disorders involving mobility disability (e.g., arthritis, chronic lung disease); neuromuscular diseases (e.g., stroke, amyotrophic lateral sclerosis); rehabilitation after trauma, surgery (including hip-replacement surgery), medical illnesses or other conditions requiring bed-rest; recovery from catabolic illnesses such as infectious or neoplastic conditions; metabolic or hormonal disorders (e.g., diabetes mellitus, hypogonadal states, thyroid disease); response to medications (e.g., glucocorticoids, thyroid hormone); malnutrition
  • the methods of the invention are also useful for screening test compounds to identify therapeutic compounds that increase total body skeletal muscle mass.
  • the total body skeletal mass of a subject is measured according to the method before and after a test compound is administered to the subject.
  • the assessment of total body skeletal muscle mass can be repeated at appropriate intervals to monitor the effect of the test compound on total body skeletal muscle mass.
  • a dose of 0.475 mg D3-creatine per rat was determined to be rapidly and completely absorbed and reach the systemic circulation with minimal urinary spillage, such that >99% of the D3-creatine tracer dose should be available to equilibrate with the body creatine pool.
  • the creatine dilution method was then used to determine urinary D3-creatine enrichment and the time to isotopic steady state in growing rats.
  • a single oral dose of 0.475 mg D3-creatine per rat was given to two groups of rats, 9 and 17 weeks of age, and urine was collected at 24, 48, and 72 hour time points after dosing.
  • MPE mole percent excess
  • FIG. 1B shows the total body creatine pool sizes calculated from urinary enrichment 72 h after the tracer dose for the 9 and 17 week-old rat groups and indicates the creatine pool size for the larger, older rats is significantly larger than for the smaller, younger rats.
  • LBM lean body mass
  • QMR quantitative magnetic resonance
  • DEXA DEXA
  • Urine pharmacokinetic analyses for each collection interval may include quantitation of MPE ratio by IRMS, ratio of deuterium-labeled creatine+deuterium-labeled creatinine to total creatine+total creatinine by LCMS, total creatinine, creatine pool size, and % of deuterium-labeled creatine dose excreted in urine.
  • Steady-state enrichment can be assessed both visually and from the estimate of the slope from the linear regression of enrichment (MPE) vs time (midpoint of each urine collection interval).
  • a mixed effect ANOVA model can be fit with time (continuous variable) as a fixed effect and subject as a random effect. The coefficient for the slope of the time effect can be used to evaluate steady-state. The 90% confidence intervals for the slope can be calculated.
  • Creatine pool size can be estimated once steady-state enrichment has been achieved a for each collection interval during steady-state according to the formula: [Amount of D3 Cr dosed (g) ⁇ total Amount of urinary D3 Cr(0 ⁇ t) (g)]/enrichment ratio(t) where t is the urine collection interval during steady-state.
  • Muscle mass can be estimated from the creatine pool size by assuming that the creatine concentration is 4.3 g/kg of whole wet muscle mass (WWM) (Kreisberg (1970) J Appl Physiol 28:264-7).
  • Muscle mass creatine pool size/Cr concentration in muscle
  • Creatine pool size can also be estimated by total urine creatinine (moles/day) divided by K (1/day).
  • the excretion rate constant (K) can be estimated using a rate excretion method by estimating the declining slope of the line for the log of the amount of D3-creatine in urine collection interval vs. time (midpoint of that urine collection interval) for each collection interval over time. This estimate of K can be used in calculating creatine pool size from 24 hr urinary creatinine excretion rather than using an estimate of turnover form the literature.
  • the separation of D3-creatine was carried out using an Acquity UPLC (Waters Corp., Milford, Ma.) equipped with a Zorbax Hilic Plus silica analytical column (50 ⁇ 2.1 mm, Rapid Resolution HD 1.8 ⁇ , Agilent Corp., Santa Clara Calif.). Injection volume is typically 8 ⁇ L.
  • Mobile phase A (MP A) consisted of 10 mM ammonium formate in water and mobile phase B is acetonitrile. Gradient chromatography was employed with initial mobile phase composition of 2% 10 mM ammonium formate with a flow rate of 0.7 mL/min. This was held for 0.5 minute and then a linear gradient to 50% MPA was achieved at 2.3 minutes. This was immediately increased to 80% and held for 0.4 minutes and then returned to starting conditions at 2.9 minutes. The total run time was 3.5 minutes. This gradient allowed baseline separation of the D3-creatine from interfering compounds.
  • the detection of D3-creatine was carried out using a Sciex API5000 (Applied Biosystems, Foster City, Calif.).
  • the HPLC system was connected to the API5000 through a turbo ion spray source operating in positive ionization mode using the following parameters: ionization temperature of 650° C., ionspray voltage of 2500 V, curtain gas setting of 45 (N 2 ), nebulizer gas setting was 65 (N 2 ), drying gas setting was 70 (N 2 ), collision gas setting of 3 (N 2 ). All other mass spectrometer parameters were optimized for the individual transitions.
  • the separation of the creatinine and D3-creatinine analytes were carried out using an Acquity UPLC (Waters Corp., Milford, Mass.) equipped with a Zorbax Hilic Plus silica analytical column , dimensions of 50 ⁇ 2.1 mm (Rapid Resolution HD 1.8 ⁇ , Agilent Corp., Santa Clara Calif.). Injection volume was typically 5 ⁇ L.
  • Mobile phase A consisted of 5 mM ammonium formate and mobile phase B was acetonitrile.
  • Gradient chromatography was employed with initial mobile phase composition of 2% 5 mM ammonium formate with a flow rate of 0.7 mL/min. This was held for 0.4 minute and then a linear gradient to 40% MPA was achieved at 2.1 minutes. This was immediately increased to 50% at 2.2 minutes and held for 0.4 minutes and then returned to starting conditions at 2.7 minutes. The total run time was 3.5 minutes. This gradient allowed baseline separation of the d3-creatinine and creatinine from interfering compounds.
  • the detection of the creatinine and D3-creatinine analytes was carried out using a Sciex API5000 (Applied Biosystems, Foster City, Calif.).
  • the HPLC system was connected to the API5000 through a turbo ion spray source operating in positive ionization mode using the following parameters: ionization temperature of 350° C., ionspray voltage of 5500 V, curtain gas setting of 45 (N 2 ), nebulizer gas setting was 60 (N 2 ), drying gas setting was 65 (N 2 ), collision gas setting of 3 (N 2 ). All other mass spectrometer parameters were optimized for the individual transitions.
  • MRM ion transitions
  • Endogenous creatinine concentration values are determined in human urine clinical samples using a D3-creatinine calibration standard curve.
  • the D3-creatinine isotope behaves similarly to creatinine throughout the extraction and HPLC-MS/MS procedures, thus allowing clean urine matrix to prepare standards and QC samples.
  • the MRM of (M+2) endogenous creatinine (116/44) is monitored.
  • a correction factor that represents the ratio of the MRM of 116/44 to 114/44, is used to correct the calculated concentrations determined from the d3-creatinine calibration curve.
  • the isotope ratio (M+2) MRM/(M+0) MRM or correction factor is 0.00286. Therefore, the amount of D3-creatinine, which would come from the D3 creatine dose and the endogenous creatinine, can be quantitated from the single D3-creatinine calibration curve.
  • Acetonitrile and Water purchased from Sigma Aldrich (St. Louis, Mo.).
  • Ammonium Formate purchased from Sigma Aldrich (St. Louis, Mo.).
  • Reference Standards of d3-Creatine (monohydrate) and d3-creatinine were purchased from CDN Isotopes, Montreal Canada.
  • Stock solutions of d3-creatine and d3-creatinine are prepared at 1.0 mg/mL in water and confirmation of equivalence is performed. Dilute solutions ranging from 0.1 ⁇ g/mL to 100 ⁇ g/mL and 0.2 ⁇ g/mL to 200 ⁇ g/mL are prepared in water and used to prepare calibration standards and quality control (QC) samples in human urine for d3-creatine and d3-creatinine, respectively.
  • Isotopically labelled internal standards for creatine (SIL) ( 13 C 3 2 H 3 15 N 1 -creatine) and creatinine (SIL) ( 13 C 3 2 H 4 15 N 1 -creatinine) are prepared at 1.0 mg/mL in water. Dilute solutions of these are prepared at 500 ng/mL in acetonitrile and used as an extraction solvent for the urine standards, quality controls and study samples.
  • Sample Preparation (d3-creatine, creatinine and d3-creatinine in urine) A 200 ⁇ L aliquot of the internal standard working solution (500 ng/mL) in acetonitrile is added to each well, except double blank samples, acetonitrile is added. A 40 ⁇ L aliquot of sample, standard or QC is transferred to the appropriate wells in the plate containing the SIL. The plate is sealed and vortex mixed for approximately 3 minutes. The plate is centrifuged at approximately 3000 g for 5 minutes. Supernatant is transferred to a clean 96 well plate and then injected onto the HPLC-MS/MS system for analysis. D3-creatine and d3-creatinine are analyzed from separate human urine samples.
  • the separation of d3-creatine, d3-creatinine and creatinine is carried out using an Acquity UPLC (Waters Corp., Milford, Mass.) equipped with a Agilent Zorbax Hilic Plus silica analytical column, dimensions of 50 ⁇ 2.1 mm (Rapid Resolution HD 1.8 ⁇ , Agilent Corp., Santa Clara Calif.). Injection volume is typically 2 ⁇ L.
  • mobile phase A consists of 10 mM ammonium formate and mobile phase B is acetonitrile.
  • Gradient chromatography is employed with initial mobile phase composition at 2% 10 mM ammonium formate with a flow rate of 0.7 mL/min. This is held for 0.5 minute and then a linear gradient to 50% MPA is achieved at 2.3 minutes. This is increased to 80% over 0.2 minutes and held for 0.4 minutes and then returned to starting conditions at 3.0 minutes. The total run time is 3.5 minutes.
  • the detection of d3-creatine is carried out using a Sciex API5000 (Applied Biosystems, Foster City, Calif.).
  • the HPLC system is connected to the API5000 through a turbo ion spray source operating in positive ionization mode using the following parameters: ionization temperature of 650° C., ionspray voltage of 2500 V, curtain gas setting of 45 (N 2 ), nebulizer gas setting is 65 (N 2 ), drying gas setting is 70 (N 2 ), collision gas setting of 3 (N 2 ). All other mass spectrometer parameters are optimized for the individual transitions.
  • D3-creatinine mobile phase A consisted of 5 mM ammonium formate, and mobile phase B is acetonitrile. Gradient chromatography is employed with initial mobile phase composition at 2% 5 mM ammonium formate with a flow rate of 0.7 mL/min. This is held for 0.4 minute and then a linear gradient to 60% acetonitrile is achieved at 2.1 minutes. This is immediately increased to 50% acetonitrile and held for 0.4 minutes and then returned to starting conditions at 2.7 minutes. The total run time is 3.5 minutes. The detection of the creatinine and d3-creatinine analytes is carried out using a Sciex API5000 (Applied Biosystems, Foster City, Calif.).
  • the HPLC system was connected to the API5000 through a turbo ion spray source operating in positive ionization mode using the following parameters: ionization temperature of 350° C., ionspray voltage of 5500 V, curtain gas setting of 45 (N 2 ), nebulizer gas setting was 60 (N 2 ), drying gas setting was 65 (N 2 ), collision gas setting of 3 (N 2 ). All other mass spectrometer parameters are optimized for the individual transitions.
  • the M+2 isotope MRM is acquired to avoid diluting the sample with a surrogate matrix (a creatinine free control urine is not available).
  • a creatinine free control urine is not available.
  • These isotopes will behave similarly throughout the extraction and HPLC-MS/MS procedures, thus allowing clean urine matrix to prepare standards and QC samples as well as allowing for the quantification of endogenous creatinine using a calibration curve that was generated from the deuterated form of creatinine. Therefore, the amount of d3-creatinine and the endogenous creatinine, can be quantitated from the single d3-creatinine calibration curve.
  • HPLC-MS/MS data were acquired and processed (integrated) using AnalystTM software (Version 1.4.2, MDS Sciex, Canada).
  • AnalystTM software Version 1.4.2, MDS Sciex, Canada.
  • a calibration plot of area ratio versus d3-creatinine concentration was constructed and a weighted 1/x 2 linear regression applied to the data.
  • a surrogate matrix or a surrogate analyte must be used.
  • human urine can be used since d3-creatinine is not found endogenously and the quantification of creatinine can be determined from the d3-creatinine calibration curve. The equivalency of d3-creatinine and creatinine is shown.
  • This method is used to determine the amount of d3 creatinine in human urine that has been converted from a dose of d3 creatine. Additionally, the amount of endogenous creatinine will be determined using the d3 creatinine standard curve. The amount of endogenous creatinine is much greater (1000 fold) than the levels of d3-creatinine in the human clinical urine samples, therefore instead of diluting the sample, the M+2 isotope of creatinine will be monitored. This will allow the simultaneous measurement of creatinine and d3-creatinine from one sample using a urine matrix calibration curve. The peak area of the MRM of (M+2) endogenous creatinine (116/44) is monitored along with the d3 creatinine MRM of 117/47. A correction factor that represents the ratio of the MRM of 116/44 to 114/44, is used to correct the calculated concentrations determined from the d3-creatinine calibration curve.
  • the isotope ratio is determined using two different experimental procedures.
  • the original experimental design uses one standard concentration, a 200 ng/mL creatinine solution (Table 2a).
  • the peak area of the creatinine is monitored at both the M+0 and M+2 MRM transitions (114/44 and 116/44), respectively.
  • One solution was used to reduce variation which may occur from separate injections and preparation of separate solutions.
  • This concentration is chosen because it allows the peak area of both MRMs to be in the detector range, and with adequate signal to noise for the smaller peak.
  • some variability in the day to day measurements is observed ( ⁇ 10%) as shown in Table 3. Therefore, an additional experiment to generate this response ratio was performed.
  • the response ratio is experimentally determined using two separate solutions.
  • a separate solution for each MRM transition is prepared which gives peak areas that are closer in magnitude to each other.
  • a 10 ng/mL solution of creatinine is used to acquire the MRM transition of 114/44 and a 500 ng/mL solution is used to acquire the MRM transition of 116/44.
  • These solutions are injected on the LC/MS/MS system in replicates of 10 and the mean peak area ratio (PAR) for each solution is determined.
  • the response ratio is then calculated by dividing the mean PAR of 116/44 by the corrected PAR of 114/44.
  • the PAR from the 10 ng/mL solutions is multiplied by 50 (since 500 ng/mL is 50 times larger than the 10 ng/mL), an example is shown in Table 2b. This allows the peak area of both solutions to be closer in value and potentially eliminating errors associated with integrating peaks with vastly different signal to noise values.
  • the corrected peak area ratio would be equivalent to a 500 ng/mL creatinine standard monitoring the peak area of the MRM transition of 114/44.
  • the isotope ratio (response ratio) was determined on multiple occasions over a four month time span and on two different triple quadrapole instruments. The mean of these nine values was determined and the inverse of this response ratio is the dilution factor used to correct the creatinine values in the LIMS system. See Table 3.

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