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A New Simultaneous Measurement of Lysosphingolipids by LC-MS/MS

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A New Simultaneous Measurement of Lysosphingolipids by LC-MS/MS Clin Chem Lab Med 2017; 55(3): 403–414 Open Access Giulia Polo, Alessandro P. Burlina, Thilini B. Kolamunnage, Michele Zampieri, Carlo Dionisi-Vici, Pietro Strisciuglio, Martina Zaninotto, Mario Plebani and Alberto B. Burlina* Diagnosis of sphingolipidoses: a new simultaneous measurement of lysosphingolipids by LC-MS/MS DOI 10.1515/cclm-2016-0340 population. The results demonstrate that the LC-MS/ Received April 21, 2016; accepted July 15, 2016; previously published MS method can quantify different LysoSLs and can be online August 17, 2016 used to identify patients with Fabry (LysoGb3), Gaucher Abstract and Krabbe (HexSph) diseases, prosaposine deficiency (LysoGb3 and HexSph), and Niemann-Pick disease types Background: Lysosphingolipids (LysoSLs) are deriva- A/B and C (LysoSM and LysoSM-509). tives of sphingolipids which have lost the amide-linked Conclusions: This LC-MS/MS method allows a rapid and acyl chain. More recently, LysoSLs have been identi- simultaneous quantification of LysoSLs and is useful as a fied as storage compounds in several sphingolipidoses, biochemical diagnostic tool for sphingolipidoses. including Gaucher, Fabry and Niemann-Pick diseases. To Keywords: Fabry; Gaucher; glucosylsphingosine; Krabbe; date, different methods have been developed to measure LC-MS/MS; LysoGb3; lysosphingolipids; lysosphingomy- each individual lysosphingolipid in plasma. This report elin; Niemann-Pick; psychosine. describes a rapid liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) assay for simulta- neous quantification of several LysoSLs in plasma. Introduction Methods: We analyzed the following compounds: hexo- sylsphingosine (HexSph), globotriaosylsphingosine Sphingolipidoses are a group of inherited lysosomal storage (LysoGb3), lysosphingomyelin (LysoSM) and lysosphin- disorders (LSD) caused by defects in the lysosomal degrada- gomyelin-509 (LysoSM-509). The sample preparation tion of sphingolipids (Figure 1) [1, 2]. This group of inherited requires only 100 μL of plasma and consists of an extrac- metabolic diseases comprises (1) primary sphingolipidoses tion with a mixture of MeOH/acetone/H2O (45:45:10, v/v). caused by a defect in a gene encoding lysosomal enzyme Results: The method validation showed high sensi- [Niemann-Pick disease type A/B disease (NPA/B), Fabry tivity, an excellent accuracy and precision. Reference disease (FD), Krabbe disease (KD), Gaucher disease (GD), ranges were determined in healthy adult and pediatric Tay-Sachs disease, metachromatic leukodystrophy, GM1 and GM2 gangliosidosis]; (2) primary sphingolipidoses due to defect in activator proteins involved in degradation *Corresponding author: Dr. Alberto B. Burlina, Division of Inherited Metabolic Diseases, Department of Women and Children’s Health, pathways of sphingolipids (Saposins defects); (3) secondary University Hospital of Padua, Via Orus 2/c 35129 Padova, Italy, sphingolipidoses where there is an impairment of trafficking Phone: +39 0498217472, Fax: +39 0498217474, and fusion in the endocytic system [Niemann-Pick disease E-mail: [email protected] type C (NPC)]. Many sphingolipidoses share common symp- Giulia Polo, Thilini B. Kolamunnage and Michele Zampieri: Division toms and signs and clinicians are facing difficulties in diag- of Inherited Metabolic Diseases, Department of Women and nostic process. Biochemical investigation of the nature of a Children’s Health, University Hospital of Padova, Padova, Italy Alessandro P. Burlina: Neurology Unit, St. Bassiano Hospital, possible storage product will provide an important clue, and Bassano del Grappa, Italy direct enzyme and/or molecular analysis facilitate the final Carlo Dionisi-Vici: Metabolic Unit, Department of Pediatric diagnosis. A leading method of analysis, liquid chromatog- Medicine, Bambino Gesù Children’s Hospital, Rome, Italy raphy coupled with tandem mass spectrometry (LC-MS/ Pietro Strisciuglio: Department of Translational Medical Sciences, MS), is a highly selective and sensitive tool for biomarker Section of Pediatrics, “Federico II” University, Naples, Italy Martina Zaninotto and Mario Plebani: Department Laboratory measurement. The main advantage of this technique is the Medicine, University Hospital of Padova, Padova, Italy. possibility to identify various molecular species of different http://orcid.org/0000-0002-0270-1711 (M. Plebani) classes in crude biological samples. LC-MS/MS detection of ©2016, Alberto B. Burlina et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. 404 Polo et al.: Simultaneous measurement of lysosphingolipids by LC-MS/MS GM1 Gb4 β β β β β α β β Cer Cer GM-1 gangliosidosis GLB Sandhoff HEXA GM2-AP sap-B HEXB Lyso-Gb3 GM2 β β β Gb3 α ββ Cer Cer Tay-Sachs, Sandhoff HEXA GM2-AP GM3 GLA β β Cer sap-B Fabry Gb2 α β Cer NA sap-B GLA LacCer sap-B β β Cer GalCer Sulfatide GalSph MLD β β GLB Cer Cer sap-A,C ASA SO sap-B GlcCer GlcSph β Cer GALC sap-A,C ABG Krabbe Gaucher sap-C ASM LysoSM Glc Ceramide Sphingomyelin Gal NPA/B Farber CER GalNAc sap-C,D LysoSM-509 NeuAc ? Sphingosine Figure 1: Sphingolipid degradation pathway and related sphingolipidoses. The names of individual inherited diseases are indicated in the blue boxes. Degrading enzymes are given as acronyms in Italic, activator proteins required for the respective degradation step in vivo in blue. Lysosphingolipids (LysoSLs) are indicated in the red boxes. The precise structure of LysoSM-509 has not yet been elucidated. ABG, glucocerebroidase; ASA, arylsulphatase A; ASM, acid sphingomyelinase; CER, ceramidase; Gal, galactose; GALC, galactocerebrosidase; GalCer, galactosylceramide; GalNAc, N-acetylgalactosamine; Gb2, Galabiosylceramide; Gb3, globotria- osylceramide; Gb4, globotetraosylceramide; GLA, α-galactosidase A; GLB, β-galactosidase; Glc, glucose; GlcCer, glucosylceramide; GM1, GM1 ganglioside; GM2, GM2 ganglioside; GM2-AP, GM2-activator protein; GM3, GM3 ganglioside; HEXA, β-hexosaminidase A; HEXB, β-hexosaminidase B; LacCer, lactosylceramide; MLD, metachromatic leukodystrophy; NA, neuraminidase; NeuAc, N-acetilneuraminic acid; sap, saposin. oxysterols is a great example of the potential of this tech- forms of LysoSLs have been reported in different sphin- nique for NPC diagnosis [3]. golipidoses (Figure 1). Increased levels of plasma and Recently, investigations of the metabolism and bio- urine globotriaosylsphingosine (LysoGb3) are seen in logical functions of sphingolipid biomolecules have males with FD [6, 7] and in heterozygote females [8]. Two increased. As a result, more accurate methods of analyz- hexosylsphingosines (HexSph), galactosylsphingosine ing sphingolipids by LC-MS/MS have been developed. It (GalSph) and glucosylsphingosine (GlcSph), respectively, has been shown that glycosphingolipids are elevated in were increased in patients with KD [9, 10] and GD [4]. The sphingolipidoses; however, these primary storage mol- deacetylated form of sphingomyelin, lysosphingomyelin ecules had low sensitivity and specificity, making them (LysoSM) is elevated in NPA/B and NPC [11, 12]. Recently, unsuitable as biomarkers [4]. In contrast, lysosphin- a novel biomarker, lyso-sphingomyelin-509 (LysoSM-509), golipids (LysoSLs), the N-deacetylated lyso-forms of gly- has been established for the primary diagnosis of NPC cosphingolipids, have been reported to increase markedly [13]. These molecules are involved in numerous cellular in patients with sphingolipidoses, indicating that they biochemical processes [14] and are assumed to be directly have the potential to be useful biomarkers for both diag- involved in the pathophysiological mechanisms of neuro- nosis and monitoring of treatment effects [5]. Specific degeneration [2]. Polo et al.: Simultaneous measurement of lysosphingolipids by LC-MS/MS 405 This paper describes an efficient and fast LC-MS/ the diagnosis was confirmed by demonstration of marked enzyme MS method for simultaneous quantification of several deficiency and/or by mutation analysis. Ethical approval was obtained from the Ethics Committee of Padua Hospital. LysoSLs: HexSph (GalSph+GlcSph), LysoGb3 and LysoSM, including the new biomarker LysoSM-509. The first aim was to determine reference ranges for LysoSLs in healthy Calibration standards and quality controls (QCs) pediatric and adult subjects to guarantee diagnostic effi- preparation ciency and better monitoring of treated patients. Fur- thermore, the diagnostic potential of HexSph, LysoGb3, Stock standard solutions were prepared by dissolving powders in a LysoSM and LysoSM-509 was confirmed determining solvent mixture of chloroform/methanol (2/1, v/v) at different final levels in patients with LSD and those suspected of having concentrations: 0.5 mg/mL GlcSph and GlcSph-P, 1 mg/mL LysoSM, LSD. In addition, we designed a qualitative LC-MS/MS 0.1 mg/mL LysoGb3. GlcSph was used as the HexSph standard for method to separate GlcSph from the isobaric molecule calibration curve and quality controls. A working solution in chlo- roform/methanol (2/1, v/v) at a concentration of 10 μmol/L was GalSph as a confirmatory test in presence of a high peak prepared for each standard. All stock and working solutions of stand- of HexSph with the first assay. ards were stored at –20 °C. The precipitation solution with internal standard (GlcSph-P) was prepared by diluting the working solution with methanol/acetone/H2O (45:45:10, v/v) at a concentration of 10 nmol/L and stored at –80 °C. Materials and methods An eight-level calibration curve was
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