HPLC for urinary catecholamines and metanephrines with alpha-methyldopa

Urinary sampling for 5HIAA and metanephrines determination: revisiting the recommendations

CONTEXT

Biogenic amines such as 5-hydroxy-indole acetic acid (5HIAA) the main metabolite of serotonin or metanephrines (catecholamines metabolites) are used as biomarkers of neuroendocrine tumours.

OBJECTIVE

To re-evaluate the recommendations for urinary sampling (preservatives, diet, drugs, etc.) as many of the reported analytical interferences supporting these recommendations are related to obsolete assays.

METHODS

Bibliographic analysis of old and modern assays concerning preservation, extraction, assay and interferences.

RESULTS

5HIAA may degrade as soon as urine is excreted. Thus, acids as preservatives (hydrochloric or acetic acid) have to be immediately added. Care should be taken not to decrease the pH under 2. Urine preservative for metanephrine assays is not mandatory. Diets including serotonin-, tryptophan- and dopamine-rich foods have to be avoided depending on the biomarkers investigated (bananas, plantain, nuts, etc.). Tryptophan-rich over-the-counter formulas have to be prohibited when 5HIAA has to be assayed. Acetaminophen may interfere with electrochemical detection depending on high-pressure liquid chromatography (HPLC) parameters. No interference is known with mass spectrometric assays but with the one described for metanephrines determination. Some drugs interfere however with serotonin and catecholamines secretion and/or metabolism (monoamine oxidase inhibitors, serotonin or dopamine recapture inhibitors, etc.).

CONCLUSION

Revisited recommendations are provided for the diet, the drugs and the preservatives before HPLC coupled with electrochemical and mass spectrometry assays.

Pathophysiology and diagnosis of disorders of the adrenal medulla: focus on pheochromocytoma

The principal function of the adrenal medulla is the production and secretion of catecholamines. During stressful challenging conditions, catecholamines exert a pivotal homeostatic role. Although the main adrenomedullary catecholamine, epinephrine, has a wide array of adrenoreceptor-mediated effects, its absence does not cause life-threatening problems. In contrast, excess production of catecholamines due to an adrenomedullary tumor, specifically pheochromocytoma, results in significant morbidity and mortality. Despite being rare, pheochromocytoma has a notoriously bad reputation because of its potential devastating effects if undetected and untreated. The paroxysmal signs and symptoms and the risks of missing or delaying the diagnosis are well known for most physicians. Nevertheless, even today the diagnosis is still overlooked in a considerable number of patients. Prevention and complete cure are however possible by early diagnosis and appropriate treatment but these patients remain a challenge for physicians. Yet, biochemical proof of presence or absence of catecholamine excess has become more easy and straightforward due to developments in assay methodology. This also applies to radiological and functional imaging techniques for locating the tumor. The importance of genetic testing for underlying germline mutations in susceptibility genes for patients and relatives is increasingly recognized. Yet, the effectiveness of genetic testing, in terms of costs and benefits to health, has not been definitively established. Further improvement in knowledge of genotype-phenotype relationships in pheochromocytoma will open new avenues to a more rationalized and personalized diagnostic approach of affected patients.

Determination of catecholamines in plasma and urine

For more than 20 years, measurement of catecholamines in plasma and urine in clinical chemistry laboratories has been the cornerstone of the diagnosis of neuroendocrine tumors deriving from the neural crest such as pheochromocytoma (PHEO) and neuroblastoma (NB), and is still used to assess sympathetic stress function in man and animals. Although assay of catecholamines in urine are still considered the biochemical standard for the diagnosis of NB, they have been progressively abandoned for excluding/confirming PHEOs to the advantage of metanephrines (MNs). Nevertheless, catecholamine determinations are still of interest to improve the biochemical diagnosis of PHEO in difficult cases that usually require a clonidine-suppression test, or to establish whether a patient with PHEO secretes high concentrations of catecholamines in addition to metanephrines. The aim of this chapter is to provide an update about the catecholamine assays in plasma and urine and to show the most common pre-analytical and analytical pitfalls associated with their determination.

Chemoreceptors of Escherichia coli CFT073 play redundant roles in chemotaxis toward urine

Community-acquired urinary tract infections (UTIs) are commonly caused by uropathogenic Escherichia coli (UPEC). We hypothesize that chemotaxis toward ligands present in urine could direct UPEC into and up the urinary tract. Wild-type E. coli CFT073 and chemoreceptor mutants with tsr, tar, or aer deletions were tested for chemotaxis toward human urine in the capillary tube assay. Wild-type CFT073 was attracted toward urine, and Tsr and Tar were the chemoreceptors mainly responsible for mediating this response. The individual components of urine including L-amino acids, D-amino acids and various organic compounds were also tested in the capillary assay with wild-type CFT073. Our results indicate that CFT073 is attracted toward some L- amino acids and possibly toward some D-amino acids but not other common compounds found in urine such as urea, creatinine and glucuronic acid. In the murine model of UTI, the loss of any two chemoreceptors did not affect the ability of the bacteria to compete with the wild-type strain. Our data suggest that the presence of any strong attractant and its associated chemoreceptor might be sufficient for colonization of the urinary tract and that amino acids are the main chemoattractants for E. coli strain CFT073 in this niche.

Determination of free and conjugated normetanephrine and metanephrine in human plasma by high-performance liquid chromatography with electrochemical detection

A simple method for the simultaneous assay of normetanephrine and metanephrine (both free and conjugated) in human plasma by high-performance liquid chromatography with electrochemical detection has been developed. The hydrolysed plasma is purified on a Dowex 50 H+ column, and the methoxylated amines are eluted with ammonia-methanol. The methoxyamines are assayed using a dual-series electrode arrangement with differential current measurement. This system greatly improves the assay specificity toward endogenous or exogenous metabolites and drugs. The high sensitivity of the method enables the determination in normal subjects of levels of normetanephrine and metanephrine.

Catecholamines and their metabolites

The research on biosynthesis, physiology, pharmacology, regulation and degradation of catecholamines has continuously increased for more than 50 years. This is not unexpected because of the fact that catecholamines are involved in so many life processes such as nerve conduction, blood circulation and hormone regulations in health and disease. This demands that methods for their determination should be improved, and in fact during the years a number of analytical methods have been published. About 20 years ago radioenzyme techniques with thin-layer chromatographic (TLC) separation of radiolabelled catecholamine derivatives were developed which greatly contributed to our knowledge of physiological concentrations of catecholamines in biological media, particularly in plasma and brain. Radioimmune methods were successful for analysis of a number of analytes, but for catecholamines radioimmunoassays developed slowly. We believe that the greatest potential for radioimmunochemical methods lies in their ability to localize catecholamines and metabolites at the cellular and subcellular levels. With the advent of gas chromatographic-mass spectrometric (GC-MS) and high-performance liquid chromatographic (HPLC) procedures analysis of catecholamines improved greatly., The equipment for GC-MS is expensive and requires technical skillfulness, but in experienced hands a lot of new biological data have emerged. An outstanding quality with GC-MS is that the method offers the ability to identify unknown compounds and is relatively free from interferences from extraneous compounds. In comparison with GC-MS, HPLC is versatile and has gained a widespread use. Applications for research in the catecholamine field are numerous. In general, the sensitivity and specificity are satisfactory with HPLC, but it should be borne in mind that a number of pitfalls can obscure the results. This involves both sample handling, clean-up and chromatographic procedures. At present, HPLC is the most expanding field in chromatographic determination of catecholamines and their metabolites. This is particularly the case for HPLC with electrochemical detection which has revolutionized our analytical potential in this field. These chromatographic procedures continue to develop. The prerequisites for further improved methods such as capillary zone electrophoresis and combined HPLC-MS are at hand and hopefully will soon come into more general use for analysis of catecholamines in biological samples.