Improved stable isotope dilution-gas chromatography-mass spectrometry method for serum or plasma free 3-hydroxy-fatty acids and its utility for the study of disorders of mitochondrial fatty acid beta-oxidation

BACKGROUND

Disorders of fatty acid oxidation (FAO) are difficult to diagnose, primarily because in many of the FAO disorders measurable biochemical intermediates accumulate in body fluids only during acute illness. Increased concentrations of 3-hydroxy-fatty acids (3-OH-FAs) in the blood are indicative of FAO disorders of the long- and short-chain 3-hydroxy-acyl-CoA dehydrogenases, LCHAD and SCHAD. We describe a serum/plasma assay for the measurement of 3-OH-FAs with carbon chain lengths from C(6) to C(16).

METHODS

We used stable isotope dilution gas chromatography-mass spectrometry (GC-MS) with electron impact ionization and selected ion monitoring. Natural and isotope-labeled compounds were synthesized for the assay.

RESULTS

The assay was linear from 0.2 to 50 micromol/L for all six 3-OH-FAs. CVs were 5-15% at concentrations near the upper limits seen in healthy subjects. In 43 subjects, the medians (and ranges) in micromol/L were as follows: 3-OH-C(6), 0.8 (0.3-2.2); 3-OH-C(8), 0.4 (0.2-1.0); 3-OH-C(10), 0.3 (0.2-0.6); 3-OH-C(12), 0.3 (0.2-0.6); 3-OH-C(14), 0.2 (0.0-0.4); and 3-OH-C(16), 0.2 (0.0-0.5). 3-OH-FAs were increased in infants receiving formula containing medium chain triglycerides. Two patients diagnosed with LCHAD deficiency showed marked increases in 3-OH-C(14) and 3-OH-C(16) concentrations. Two patients diagnosed with SCHAD deficiency showed increased shorter chain 3-OH-FAs but no increases in 3-OH-C(14) to 3-OH-C(16).

CONCLUSION

Measuring blood concentrations of the 3-OH-FAs with this assay may be a valuable tool for helping to rapidly identify deficiencies in LCHAD and SCHAD and may also provide useful information about the status of the FAO pathway.

Serine and glycine metabolism in hepatocytes from mid gestation fetal lambs

Using stable isotopes of serine, glycine, and glutamine, the metabolism of serine and glycine was investigated in primary hepatocytes from six mid-gestation fetal lambs (mean gestational age = 81 +/- 6 d, normal gestation = 145 d). Serine production was 6.84 +/- 1.22 mumol/24 h/mg of DNA and exceeded serine utilization (3.76 +/- 1.44 mumol/24 h/mg of DNA) with a resultant net increase in medium serine of 2.58 +/- 1.70 mumol/24 h/mg of DNA. In contrast, glycine production (6.84 +/- 1.16 mumol/24 h/mg of DNA) was less than glycine utilization (12.10 +/- 1.78 mumol/24 h/mg of DNA) with a net decline in medium glycine of -5.44 +/- 2.03 mumol/24 h/mg of DNA. Of the serine produced, 50.4 +/- 4.3% was derived from glycine via the action of serine hydroxymethyltransferase (SHMT) and the glycine cleavage enzyme complex (GCS). Increasing the medium serine concentration resulted in an increase in serine utilization and sparing of the utilization of other amino acids. Biosynthesis of glycine from serine accounts for only 18.1 +/- 5.6% of glycine production, and this percentage is not affected by changes in medium serine concentration. Using 2.5-[15N2]glutamine as the tracer, an estimated 18 +/- 7% of serine production was derived from transamination reactions. The specific activity of both cytosolic and mitochondrial SHMT was constant for the duration of the cultures. We conclude that, in mid-gestation fetal ovine hepatocytes, there is net production of serine (with glycine as the primary metabolic source of this serine biosynthesis) and net glycine utilization. These data suggest that flux through SHMT and GCS accounts for 50% of serine biosynthesis in mid-gestation fetal ovine hepatocytes. The sparing of the utilization of other amino acids by serine suggests that serine a conditionally essential amino acid for the mid-gestation fetal liver.

Pathways of serine and glycine metabolism in primary culture of ovine fetal hepatocytes

Previous in vivo studies in the ovine fetus have demonstrated net serine production by the fetal liver, a pattern not seen in the adult sheep. The goal of this study was to determine the major metabolic pathways responsible for fetal hepatic serine production by using stable isotope methodology in primary culture of late gestation ovine fetal hepatocytes. Specifically selected tracers of glycine were added to individual cultures, with production of labeled serine determined after 24 h of incubation. When [1-13C1]glycine or [2-13C1]glycine was used as the initial tracer, serine enrichment at 24 h indicated that approximately 30% of serine production comes from glycine. Quantitative comparison of serine enrichment from these two tracers suggests that serine synthesis from glycine occurs via the combined action of the glycine cleavage enzyme system (GCE) and serine hydroxymethyltransferase (SHMT). Using [1,2-13C2(15)N1]glycine as the tracer, there was no significant increase in M + 2 glycine in the medium over 24 h, suggesting no reversible transamination of glycine, and therefore no significant movement of glycine through the glyoxalate pathway. These data demonstrate that in primary culture of fetal ovine hepatocytes, approximately 30% of serine biosynthesis is derived from glycine, primarily via the combined action of GCE and SHMT.

The identification of trimethylamine excess in man: quantitative analysis and biochemical origins

The underlying biochemical causes of chronic odor problems in humans have attracted only a few investigators. This may be due, in part, to intermittent odor complaints, to the psychological problems often associated with these patients, or to the low incidence of a true metabolic disorder. One cause of intense odor is an excessive excretion of trimethylamine (TMA) in sweat, breath, and urine and was reported to be due to a defect in the liver enzyme that converts this volatile amine to its N-oxide. Other investigators have reported TMA excess as a result of liver, kidney, and/or gastrointestinal dysfunction. We report on the development of an analytical technique for urine that can be used to identify those individuals whose chronic odor is caused by a defect in their TMA pathway. A simple extension of the basic TMA analysis can be used to measure the concentration of TMA N-oxide in the affected patients. These data can, in turn, be used to demonstrate the level of activity of the N-oxide-forming enzyme in these subjects. The results obtained from using this test on more than 50 subjects indicate, in addition to a normal population, at least two types of patients with TMA excess. One group has excess TMA excretion with low activity of the N-oxide and another group shows excess TMA excretion with normal N-oxide activity.

Quantitative analysis of disaccharides in the urine of beta-mannosidosis patients

Until recently, there have not been any confirmed reports of beta-mannosidase deficiency in man. We have now analysed urine from two patients with confirmed beta-mannosidase deficiency and have found Man-beta(1-4)GlcNAc concentrations of 65 and 73 mg/mmol creatinine. These levels are at least 12 times higher than those found in patients with other lysosomal storage diseases. The method we report for this analysis requires only 0.1 ml of urine and uses a gas chromatograph, area ratio, calibration curve for the quantitative analysis.