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Clinical utility of laboratory developed mass spectrometry assays for steroid hormone testing. J Mass Spectrom Adv Clin Lab 2023; 28:13-19. [PMID: 36756146 PMCID: PMC9900367 DOI: 10.1016/j.jmsacl.2023.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023] Open
Key Words
- ART, assisted reproductive technology
- CAP, College of American Pathologists
- CDC, Centers for Disease Control and Prevention
- CRP, C-reactive protein
- Endocrinology
- FDA, US Food and Drug Administration
- GC–MS, gas chromatography-mass spectrometry
- Immunoassay
- LC-MS/MS
- LC-MS/MS, liquid chromatography-tandem mass spectrometry
- Mass spectrometry
- NIST, National Institutes of Science and Technology
- RIA, radioimmunoassay
- RMP, Reference Measurement Procedure
- SRM, Standard Reference Material
- Sensitivity
- Specificity
- Steroid hormones
- VALID, Verifying Accurate Leading-edge IVCT Development Act of 2022
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Lot verification practices in Ontario clinical chemistry laboratories - Results of a patterns-of-practice survey. Pract Lab Med 2022; 32:e00300. [PMID: 36035320 PMCID: PMC9399155 DOI: 10.1016/j.plabm.2022.e00300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Verifying new reagent or calibrator lots is crucial for maintaining consistent test performance. The Institute for Quality Management in Healthcare (IQMH) conducted a patterns-of-practice survey and follow-up case study to collect information on lot verification practices in Ontario. Methods The survey had 17 multiple-choice questions and was distributed to 183 licensed laboratories. Participants provided information on materials used and approval/rejection criteria for their lot verification procedures for eight classes of testing systems. The case study provided a set of lot comparison data and was distributed to 132 laboratories. Responses were reviewed by IQMH scientific committees. Results Of the 175 laboratories that responded regarding reagent lot verifications, 74% verified all tests, 11% some, and 15% none. Of the 171 laboratories that responded regarding calibrator lot verifications, 39% verified all calibrators, 4% some, and 57% none. Reasons for not performing verifications ranged from difficulty performing parallel testing to high reagent cost. For automated chemistry assays and immunoassays, 23% of laboratories did not include patient-derived materials in reagent lot verifications and 42% included five to six patient materials; 58% of laboratories did not include patient-derived materials in calibrator lot verifications and 23% included five to six patient materials. Different combinations of test-specific rules were used for acceptance criteria. For a failed lot, 98% of laboratories would investigate further and take corrective actions. Forty-three percent of laboratories would accept the new reagent lot in the case study. Conclusion Responses to the survey and case study demonstrated variability in lot verification practices among laboratories. Surveyed laboratories verified new reagent lots more commonly than calibrator lots. Quality control material was used more than patient material for lot verifications. Quality control results with a new lot were compared most to 2 standard deviations. Percent difference was used most to assess patient material results between lots. Laboratories need feasible guidelines on reagent and calibrator lot verifications.
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Key Words
- CLSI, Clinical and Laboratory Standards Institute
- Calibrator
- ELISA, enzyme-linked immunosorbent assay
- GC, gas chromatography
- HPLC, high-performance liquid chromatography
- IQMH, Institute for Quality Management in Healthcare
- ISO, International Organization for Standardization
- LC-MS/MS, liquid chromatography tandem mass spectrometry
- Lot number
- PT, proficiency testing
- QC, quality control
- RIA, radioimmunoassay
- Reagent
- TSH, thyroid-stimulating hormone
- Verification
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Is methylprednisolone acetate-related insulin resistance preventable in cats? Top Companion Anim Med 2022; 49:100648. [PMID: 35202848 DOI: 10.1016/j.tcam.2022.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Methylprednisolone acetate (MPA) is often prescribed to cats despite being recognized eventually as diabetogenic. To assess MPA-related insulin resistance and evaluate the efficacy of metformin or an obesity and diabetes mellitus (O&D) adjuvant diet as protective factors, a randomized clinical trial was conducted with 28 owned cats undergoing glucocorticoid therapy. A single MPA dose of 20 mg intramuscularly was administered to each cat. Controls (n=10) received only MPA. In the diet group (n=9), replacement of their habitual diet by ad-libitum feeding of a feline commercial O&D diet (Equilíbrio O&D, Total Alimentos ADM) was made. In the metformin group (n=9), metformin chlorhydrate 25mg/cat PO/q24h was administered for 30 days. All patients were clinically evaluated at baseline (T0), day 15 (T15), and day 30 (T30) and blood draw for complete blood count, serum biochemistry, and determination of insulin concentrations. Fasting Insulin Sensitivity Index (SI), Amended Insulin to Glucose Ratio (AIGR), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and Homeostatic Model Assessment of beta-cell function (HOMA-B) were calculated based on fasting glycemia and insulinemia. All groups showed significantly higher levels (p < 0.05) of neutrophils, albumin, glucose, cholesterol, triglycerides, and serum insulin at T15. Patients in the metformin group showed also higher SI, AIGR, and HOMA-IR results at T15. Also, at T15, reduced levels (p < 0.05) of eosinophils, lymphocytes, and creatinine were documented in all groups. An MPA single dose induced changes in insulin sensitivity in cats; however, neither metformin nor O&D feeding used in this study was effective as protective factors against MPA-related insulin resistance.
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Key Words
- AAFP, American Association of Feline Practitioners
- AIGR, amended insulin to glucose ratio
- CV, coefficient of variation
- ESVE, European Society of Veterinary Endocrinology
- FDM, feline diabetes mellitus
- GLP-1, glucagon-like peptide-1
- HOMA-B, homeostatic model assessment of beta-cell function
- HOMA-IR, homeostatic model assessment of insulin resistance
- LOD, limit of detection
- MPA, methylprednisolone acetate
- O&D, obesity and diabetes
- RIA, radioimmunoassay
- SI, Fasting insulin sensitivity index
- adjuvant feeding
- diabetes mellitus
- glucocorticoid therapy
- insulinaemia
- metformin
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Composite contributions of cerebrospinal fluid GABAergic neurosteroids, neuropeptide Y and interleukin-6 to PTSD symptom severity in men with PTSD. Neurobiol Stress 2020; 12:100220. [PMID: 32435669 PMCID: PMC7231970 DOI: 10.1016/j.ynstr.2020.100220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
Given that multiple neurobiological systems, as well as components within these systems are impacted by stress, and may interact in additive, compensatory and synergistic ways to promote or mitigate PTSD risk, severity, and recovery, we thought that it would be important to consider the collective, as well as separate effects of these neurobiological systems on PTSD risk. With this goal in mind, we conducted a proof-of-concept study utilizing cerebrospinal fluid (CSF) collected from unmedicated, tobacco- and illicit substance-free men with PTSD (n = 13) and trauma-exposed healthy controls (TC) (n = 17). Thirteen neurobiological factors thought to contribute to PTSD risk or severity based on previous studies were assayed. As the small but typical sample size of this lumbar puncture study limited the number of factors that could be considered in a hierarchical regression model, we included only those five factors with at least a moderate correlation (Spearman rho > 0.30) with total Clinician-Administered PTSD Scale (CAPS-IV) scores, and that did not violate multicollinearity criteria. Three of the five factors meeting these criteria—CSF allopregnanolone and pregnanolone (Allo + PA: equipotent GABAergic metabolites of progesterone), neuropeptide Y (NPY), and interleukin-6 (IL-6)—were found to account for over 75% of the variance in the CAPS-IV scores (R2 = 0.766, F = 8.75, p = 0.007). CSF Allo + PA levels were negatively associated with PTSD severity (β = −0.523, p = 0.02) and accounted for 47% of the variance in CAPS-IV scores. CSF NPY was positively associated with PTSD severity (β = 0.410, p = 0.04) and accounted for 14.7% of the CAPS-IV variance. There was a trend for a positive association between PTSD severity and CSF IL-6 levels, which accounted for 15.3% of the variance in PTSD severity (β = 0.423, p = 0.05). Z-scores were then computed for each of the three predictive factors and used to depict the varying relative degrees to which each contributed to PTSD severity at the individual PTSD patient level. This first of its kind, proof-of-concept study bears replication in larger samples. However, it highlights the collective effects of dysregulated neurobiological systems on PTSD symptom severity and the heterogeneity of potential biological treatment targets across individual PTSD patients—thus supporting the need for precision medicine approaches to treatment development and prescribing in PTSD.
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Key Words
- 3α-HSD, 3α-hydroxysteroid dehydrogenase
- Allo + PA, sum of allopregnanolone and pregnanolone
- EIA, enzyme immunoassay
- GC-MS, gas chromatography-mass spectrometry
- HPLC, high pressure liquid chromatography
- LP, lumbar puncture
- PE, prolonged exposure therapy
- PFC, prefrontal cortex
- RIA, radioimmunoassay
- TC, trauma-exposed control
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Comparison of four clinically validated testosterone LC-MS/MS assays: Harmonization is an attainable goal. CLINICAL MASS SPECTROMETRY 2018; 11:12-20. [PMID: 34841068 DOI: 10.1016/j.clinms.2018.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
Introduction Immunoassays and liquid chromatography-tandem mass spectrometry assays are commonly employed in clinical laboratories for measurement of total testosterone in serum. Results obtained from either of these methodologies compare poorly due to differences in calibration and/or inadvertent detection of interfering substances by the immunoassays. Standardization efforts are underway, but recent studies indicate that accuracy remains an issue. Methods This study compares the results from four independently developed and validated LC-MS/MS assays for total testosterone. The calibration for each assay was verified using National Institute of Standards and Technology Standard Reference Material 971. Results Initially, one of the four assays had a mean percent difference of +11.44%, compared to the All Method Mean, but following re-verification of all five non-zero calibrator concentrations with the NIST SRM 971, the mean percent difference decreased to -4.88%. Subsequently, the agreement between all four assays showed a mean bias of <5% across the range of all testosterone concentrations (0.13-38.10 nmol/L; 3.7-1098 ng/dL), including at low concentrations of <1 nmol/L (<29 ng/dL). Conclusions Excellent agreement between four independently developed LC-MS/MS assays demonstrates that harmonization using standard reference material is attainable. However, as we found in this study, to ensure accurate calibration it is critical to validate the concentrations of new lots of calibrators.
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Key Words
- AMM, All Method Mean
- CDC, Centers for Disease Control and Prevention
- CofA, certificate of analysis
- ESI, electrospray ionization
- GC-MS, gas chromatography-mass spectrometry
- GC-MS/MS, gas chromatography-tandem mass spectrometry
- HoSt, Hormone Standardization Program
- KP, Kaiser Permanente Northern California Regional Laboratory
- LC-MS/MS, harmonization
- LC-MS/MS, liquid chromatography-tandem mass spectrometry
- Mass spectrometry
- NIST SRM 971, National Institute of Standards and Technology Standard Reference Material 971
- NIST, National Institute of Standards and Technology
- RIA, radioimmunoassay
- RMP, reference measurement procedure
- SD, standard deviation
- SPH, Department of Pathology and Laboratory Medicine, St Paul’s Hospital
- SRM, selected reaction monitoring
- Standardization
- Testosterone
- UCSD, University of California San Diego Health Center for Advanced Laboratory Medicine
- UCSF, Department of Laboratory Medicine, University of California San Francisco
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Analysis of endocrine disruption effect of Roundup ® in adrenal gland of male rats. Toxicol Rep 2015; 2:1075-1085. [PMID: 28962449 PMCID: PMC5598379 DOI: 10.1016/j.toxrep.2015.07.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 07/03/2015] [Accepted: 07/30/2015] [Indexed: 12/02/2022] Open
Abstract
The effect of Roundup® on adrenal gland steroidogenesis and signaling pathway associated with steroid production was investigated. Doses of 10, 50, 100 and 250 mg/kg bw/d Roundup® were administered for two weeks to adult male rats. The 10 mg/kg bw/d dose which reduced circulatory corticosterone levels, but did not change food consumption and body weight, was selected for further study. The expression of cholesterol receptor (low density lipoprotein receptor), de novo cholesterol synthesis enzyme (3-hydroxy-3-methylglutaryl-coenzyme A synthase), hormone-sensitive lipase, steroidogenic acute regulatory protein (StAR) mRNA and phosphorylated form was decreased. Adrenocorticotropic hormone receptor (ACTH), melanocortin-2 receptor, expression was not changed but circulatory ACTH levels and adrenal cortex protein kinase A (PKA) activity were reduced. Surprisingly, exogenous ACTH treatment rescued steroidogenesis in Roundup®-treated animals. Apoptosis was evident at 250 mg/kg bw/d, but not at 10 mg/kg bw/d dose. These results suggest that Roundup® may be inhibitory to hypothalamic–pituitary axis leading to reduction in cyclic adenosine monophosphate (cAMP)/PKA pathway, StAR phosphorylation and corticosterone synthesis in the adrenal tissue.
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Key Words
- ACTH, adrenocorticotropic hormone
- Adrenal gland
- Creb, cAMP response element-binding protein
- DAPI, 4′,6-diamidino-2-phenylindole
- DPX, distrene, plasticiser, xylene
- EDC, endocrine disrupting chemical
- EDTA, ethylenediaminetetraacetate
- EGTA, ethylene glycol tetraacetate
- EIA, enzyme Immunoassay
- ELISA, enzyme-linked immunosorbent assay
- Endocrine disruptor
- Glyphosate
- Hmgcr, 3-hydroxy-3-methylglutaryl-CoA reductase
- Hmgcs, 3-hydroxy-3-methylglutaryl-coenzyme A synthase
- Hsl, hormone-sensitive lipase
- L:D cycle, light–dark cycle
- LD50, lethal dose, 50%
- Ldlr, low density lipoprotein receptor
- Mc2r, melanocortin-2 receptor
- PBS, phosphate buffer saline
- PKA, protein kinase A
- RIA, radioimmunoassay
- RIPA buffer, radioimmunoprecipitation assay buffer
- Rat
- SD, standard deviation
- SDS PAGE, sodium dodecyl sulfate polyacrylamide gel electrophoresis
- Sr-b1, scavenger receptor class B member 1
- StAR
- StAR, steroidogenic acute regulatory protein
- Steroidogenesis
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labeling
- TdT, terminal deoxynucleotidyl transferase
- cAMP, cyclic adenosine monophosphate
- qPCR, quantitative real-time PCR
- β ME, beta mercaptoethanol
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Conazole fungicides inhibit Leydig cell testosterone secretion and androgen receptor activation in vitro. Toxicol Rep 2014; 1:271-283. [PMID: 28962244 PMCID: PMC5598417 DOI: 10.1016/j.toxrep.2014.05.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/23/2022] Open
Abstract
Conazole fungicides are widely used in agriculture despite their suspected endocrine disrupting properties. In this study, the potential (anti-)androgenic effects of ten conazoles were assessed and mutually compared with existing data. Effects of cyproconazole (CYPRO), fluconazole (FLUC), flusilazole (FLUS), hexaconazole (HEXA), myconazole (MYC), penconazole (PEN), prochloraz (PRO), tebuconazole (TEBU), triadimefon (TRIA), and triticonazole (TRIT) were examined using murine Leydig (MA-10) cells and human T47D-ARE cells stably transfected with an androgen responsive element and a firefly luciferase reporter gene. Six conazoles caused a decrease in basal testosterone (T) secretion by MA-10 cells varying from 61% up to 12% compared to vehicle-treated control. T secretion was concentration-dependently inhibited after exposure of MA-10 cells to several concentrations of FLUS (IC50 = 12.4 μM) or TEBU (IC50 = 2.4 μM) in combination with LH. The expression of steroidogenic and cholesterol biosynthesis genes was not changed by conazole exposure. Also, there were no changes in reactive oxygen species (ROS) formation that could explain the altered T secretion after exposure to conazoles. Nine conazoles decreased T-induced AR activation (IC50s ranging from 10.7 to 71.5 μM) and effect potencies (REPs) were calculated relative to the known AR antagonist flutamide (FLUT). FLUC had no effect on AR activation by T. FLUS was the most potent (REP = 3.61) and MYC the least potent (REP = 0.03) AR antagonist. All other conazoles had a comparable REP from 0.12 to 0.38. Our results show distinct in vitro anti-androgenic effects of several conazole fungicides arising from two mechanisms: inhibition of T secretion and AR antagonism, suggesting potential testicular toxic effects. These effects warrant further mechanistic investigation and clearly show the need for accurate exposure data in order to perform proper (human) risk assessment of this class of compounds.
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Key Words
- 17β-HSD3, 17β-hydroxysteroid dehydrogenase type 3
- 3β-HSD1, 3β-hydroxysteroid dehydrogenase type 1
- AR, androgen receptor
- Androgen receptor (AR)
- BMR, benchmark response
- CHO cells, Chinese hamster ovary cells
- CYP19, cytochrome P450 enzyme 19 (aromatase)
- CYP51, cytochrome P450 enzyme 51/lanosterol 14α-demethylase
- CYPRO, cyproconazole
- Conazole fungicides
- Cyp11A1, cytochrome P450 enzyme 11A
- Cyp17, cytochrome P450 enzyme 17
- Cyproconazole (PubChem CID: 86132)
- DMEM, Dulbecco's Modified Eagle Medium
- EC50, half maximal effective concentration
- EDCs, endocrine disrupting chemicals
- Endocrine disrupting chemicals (EDCs)
- FLUC, fluconazole
- FLUS, flusilazole
- FLUT, flutamide
- FP, forward primer
- FSH(R), follicle-stimulating hormone (receptor)
- Fluconazole (PubChem CID: 3365)
- Flusilazole (PubChem CID: 73675)
- H295R, human adrenocortical carcinoma cells
- HEXA, hexaconazole
- HMG-CoA red, HMG-CoA reductase
- HSD(s), hydroxysteroid dehydrogenase(s)
- Hexaconazole (PubChem CID: 66461)
- IC50, half maximal inhibitory concentration
- LH(R), luteinizing hormone (receptor)
- MA-10 Leydig cells
- MTT, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide
- MYC, myclobutanil
- Myclobutanil (PubChem CID: 6336)
- NCBI, National Center for Biotechnology Information
- PBS, phosphate-buffered saline
- PEN, penconazole
- PRO, prochloraz
- Penconazole (PubChem CID: 91693)
- Por, cytochrome P450 oxidoreductase
- Prochloraz (PubChem CID: 73665)
- REP, relative effect potency
- RIA, radioimmunoassay
- ROS, reactive oxygen species
- RP, reverse primer
- RT-qPCR, real time quantitative polymerase chain reaction
- Spermatogenesis
- StAR, steroidogenic acute regulatory protein
- T, testosterone
- TEBU, tebuconazole
- TRIA, triadimefon
- TRIT, triticonazole
- Tebuconazole (PubChem CID: 86102)
- Testosterone (T)
- Triadimefon (PubChem CID: 39385)
- Triticonazole (PubChem CID: 6537961)
- cAMP, 8-bromoadenosine 3′,5′-cyclic monophosphate
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