ESI-MS/MS quantification of 7alpha-hydroxy-4-cholesten-3-one facilitates rapid, convenient diagnostic testing for cerebrotendinous xanthomatosis

BACKGROUND

The genetic disorder cerebrotendinous xanthomatosis (CTX) frequently remains undiagnosed for many years. Left untreated CTX is associated with the development of cataracts, xanthomas and severe neurological dysfunction. The method routinely used to screen for CTX is GC-based measurement of elevated 5alpha-cholestanol from hydrolyzed plasma. A plasma test for CTX utilizing ESI-MS/MS methodology would be beneficial.

METHODS

Development of rapid, simple LC-ESI-MS/MS methodology to test plasma for CTX is described. Two hour Girard derivatization allowed for 7alpha-hydroxy-4-cholesten-3-one quantification by isotope dilution LC-ESI-MS/MS within 12 min from un-hydrolyzed affected patient plasma (5 microl).

RESULTS

Adequate sensitivity and reproducibility were achieved for quantification of 7alpha-hydroxy-4-cholesten-3-one, which demonstrated improved utility as a diagnostic marker of disease and to monitor treatment compared to 5alpha-cholestanol. The mean plasma concentration of 7alpha-hydroxy-4-cholesten-3-one in untreated CTX-affected patients (n=6) was 107-fold that in unaffected subjects (n=9), with the lowest concentration in affected patients >10-fold the highest concentration in unaffected subjects.

CONCLUSION

Quantification of the bile acid precursor 7alpha-hydroxy-4-cholesten-3-one with LC-ESI-MS/MS is a novel approach to improved diagnostic testing of plasma for CTX, amenable to high-throughput analysis and automated sample handling. Development of ESI-MS/MS methodology should make CTX testing more widely available and facilitate easier diagnosis of CTX.

Analysis of neurosterols by GC-MS and LC-MS/MS

The term neurosteroid was coined by Baulieu and colleagues in Paris towards the end of the last century to describe steroids which are synthesised in the central or peripheral nervous system [E.E. Baulieu, Psychoneuroendocrinology 23 (1998) 963-87]. This definition was restricted to side-chain "shortened" steroids with 21 carbon atoms or less, and excluded sterols and their carboxylic acids with an intact side-chain. By analogy, we now use the term neurosterol to describe C(27) sterols synthesised in the nervous system. In this review we discuss the biological importance of neurosterols, and how they are extracted, isolated, and analysed by GC-MS and LC-MS/MS, from brain and relevant body fluids. We present applications of methodology employed for analysis of specific sterols and comment on the relative merits of the methods employed. Finally, the importance of future in-depth "sterolomic" investigations of brain is highlighted.