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Diagnostic Profiling Analysis of Polyols in Urine Samples of Patients with Various Diseases Performed by Capillary Gas Chromatography

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Diagnostic Profiling Analysis of Polyols in Urine Samples of Patients with Various Diseases Performed by Capillary Gas Chromatography ANALYTICAL SCIENCES OCTOBER 1990, VOL. 6 657 Diagnostic Profiling Analysis of Polyols in Urine Samples of Patients with Various Diseases Performed by Capillary Gas Chromatography Hidehiko HAGA*, Sachiko KAMEI**, Akiyuki OHKUBo** and Terumi NAKAJIMA* *Department of Analytical Chemistry , Faculty of Pharmaceutical Sciences, University of Tokyo, Hongo, Tokyo 113, Japan **Department of Laboratory Medicine , Faculty of Medicine, University of Tokyo, Hongo, Tokyo 113, Japan A capillary gas chromatographic method, based on trifluoroacetylated polyols, was applied to a study of urinary polyols in normal subjects and in patients with various diseases. Polyol excretion patterns during fasting periods and circadian variations were studied in normal subjects. Twenty-four hour urine sample sets of normal subjects showed almost constant polyol profiles, suggesting the existence of a polyol regulation system in the body. Excretion patterns of 10 polyols were studied in 100 specimens of 24-h urine samples from patients hospitalized with various diseases. Polyol profiles showed patterns characteristic of pathological states of the diseases: such as diabetes mellitus, chronic renal failure, and chronic liver diseases. The possibility of diagnosis of several diseases by urinary polyol profiles is presented. Keywords Urinary polyols, capillary gas chromatography, diabetes mellitus, renal failure, liver diseases The clinical significance of polyols in human physio- intake, medication and exogenous polyols especially, logical fluids and tissues has been drawing attention adding more difficulties to the study of urinary polyols. recently. Several recent studies have revealed that However, it has not been known to what extent food urinary levels of some polyols may vary in diseases and medication influence urinary polyol excretion. associated with carbohydrate metabolism derangements We recently established a specific, suitable and new such as diabetes mellitus and uremia.'-3 The abnormal rapid capillary gas chromatographic method for the occurrence of various polyols in diseases with a specific profiling analysis of urinary polyols as their trifluoro- enzyme deficiency such as pentosuria4 and galactosemias acetyl derivatives.6 By this method, eleven polyols can has also been reported. However, comprehensive be determined simultaneously. detailed studies of urinary polyols in patients with In this study, by applying our method, we first various diseases have not been reported yet, partly precisely investigated patterns of urinary polyol excre- because a convenient analytical method for that tion profiles in terms of changes in fasting state, purpose has not been available. The possible sources of circadian variation and 24 h urine samples with normal urinary polyols can be divided into the following four subjects to determine normal ranges. categories: 1) part of polyols contained in food or drugs Secondly, we examined the diagnostic possibility of may be absorbed and excreted into urine without profiling analysis of urinary polyols by our method by metabolic modification; 2) polyols produced by gastro- randomly measuring 100 specimens of 24 h urine samples intestinal microorganisms may be absorbed and excreted from hospitalized patients, submitted to our clinical in urine without further modification; 3) substances laboratory center for routine urinalysis. from digested and absorbed food or drugs may be metabolized into polyols in the body; 4) endogenous constituents in the body may be metabolized into Experimental polyols. Many of the polyols have been known to occur in Urine samples nature and they may also occur in food constituents. Normal urine samples were collected over a 24-h Moreover, sorbitol and xylitol are used as substitutes period from nine subjects with no known abnormalities for saccharose. Mannitol and sorbitol are used as on a free diet (only restricting any drugs and alcoholic ingredients in several drugs. It has been known that beverages). One hundred patient urine samples were urinary excretion of polyols may be influenced by food taken randomly from 24-h urine samples of hospitalized 658 ANALYTICAL SCIENCES OCTOBER 1990, VOL. 6 patients which were submitted for routine urinalysis to were measured without modifying the original method, our clinical laboratory center. During the collection however, in case of diabetic urine whose glucose period, no preservative was used, but a sample was kept concentration was extremely high (more than 5 g/ dl), at 4° C and stored in a deep-freezer as soon as urinary the amount of Dowex 1X8 resin was increased volume was measured. Patient urine samples with only accordingly to remove excessive glucose from the urine. reference numbers were applied to analysis on a blind basis concerning patient information. Patient informa- tion such as age, sex and diagnosis was retrieved by the Results and Discussion computer system in the hospital, after the determina- tion of urinary polyols was completed. Urinarypolyol excretion during fasting The medication history of patients with abnormal Urinary excretion of eleven polyols was measured in polyol values was obtained from doctors in charge by one male and one female over 20 h during fasting. sending them questionnaires. Excretion patterns of erythritol, arabitol, xylitol, mannitol, sorbitol and myoinositol in a male, for example, are Materials shown in Fig. 1. Polyol excretion decreased gradually All the materials and apparatus used for the after the last food intake, but it increased again after determination of polyols in this study were the same 14 h. The other polyols (including iditol) also showed ones as described in our previous paper.6 Urinary similar excretion patterns as in Fig. 1. These patterns glucose and creatinine were measured by a Hitachi 726 suggest that polyols are closely related with glyco- Autoanalyzer. genolysis during fasting which has been reported to begin 14 h after the last food intake, to maintain blood Sample preparation glucose level.' The origins of urinary polyols are not One milliliter of urine was treated by the method.6 well known yet; it has been considered that diet, host When polyol concentrations were very low due to metabolism and metabolism of gastrointestinal micro- increased urinary volume, 2 ml of urine was used and organisms may be their sources. These results suggested treated by the same method. Most of the urine samples that some amount of polyols are derived from intrinsic carbohydrate metabolism. Fig. 1 Urinary polyol excretion during fasting. Last meal was taken at 19:00 (7 p. m., one hour before the first voiding). Fig. 2 Circadian variation of polyols in urine. ANALYTICAL SCIENCES OCTOBER 1990, VOL. 6 659 Circadian variation of urinary polyol excretion voidings over 24 h. Circadian variation of ten polyols To our knowledge, no precise investigation on the in urine from a normal subject is shown in Fig. 2. circadian variation of urinary polyol excretion has been Polyol excretion varied very much in terms of time, reported yet. We determined urine samples from four person and kind of polyol. No significant circadian healthy men on a free diet (only restricting any drugs rhythm was found; however, it seemed that polyol and alcoholic beverages) and by unscheduled (voluntary) excretion increased soon after the meal. When we Fig. 3 Urinary polyol profiles from normal subjects by unscheduled voiding over 24 h. Al, A2, A3 etc. indicate the orders of voidings in each subject. Abbreviations: E, eryth- ritol; T, threitol; F, fucitol; R, ribitol; A, arabitol; X, xylitol; M, mannitol; S, sorbitol; G, galactitol; I, myoinositol. 660 ANALYTICAL SCIENCES OCTOBER 1990, VOL. 6 looked at the polyol profile in the same person (normal subject C), it varied very much from one time to other time, as well as in other three normal subjects (Fig. 3). However, there was a tendency that erythritol, arabitol and mannitol were excreted in larger amounts, and fucitol, xylitol and galactitol in smaller amounts. Normal 24-h urinary polyol excretion The polyol profiles of 24-h urine samples from normal subjects on a free diet are shown in Fig. 4. In this case, all the profiles showed a very similar pattern, which was different from the patterns of urine by unscheduled voidings. The origins of urinary polyols are still uncertain, as mentioned above. Nevertheless, we found that the polyol excretion in normal 24-h urine was within a certain range with small standard deviations. Namely, it can be said that some homeo- stasis exists in urinary polyol excretions. In other words, polyols are under the regulation of carbohydrate metabolism in the body. Accordingly, we judged that 24-h urine specimens would be more suitable than spot urine samples to compare the polyol profiles of urine from different kinds of diseases. All polyol levels except for myoinositol were similar to the previously reported values.l,g-13 Myoinositol levels (5.03±3.74 mg/d) were about one sixth of the Fig. 4 Polyol profiles of 24-h urine from 4 normal subjects. values (29.8±4.9 mg/ d) reported by Clements et al.10 Abbreviations are the same as in Fig. 3. The cause of this difference is uncertain but it may be Table 1 Polyols excreted in 24-h urine (mg/g of creatinine) a. mean. b. ±S.D. *, p<0.05; **, p<0.01; N.S., not significant compared with the normal group. Ery, erythritol; Thr, threitol; Fuc, fucitol; Rib, ribitol; Ara, arabitol; Xyl, xylitol; Man, mannitol; Sor, sorbitol; Gal, galactitol; Ino, myoinositol. ANALYTICAL SCIENCES OCTOBER 1990, VOL. 6 661 頃 δ 目 h 5 ご ⑪ 凶 』 口 ぺ o ＼ bo 》 。 信 (・ 塁 ミ § ぎ ) 。』 。 § 。・ 』 2 三 。 ぎ 三。 ＼ 目 〇 げ ぢ 舞 毯 三 。 碧 〉 首 ご § 8. 』 『 二 δ・ ε 〉 茎刷 ⊃・ 邸 b。 曾・ δ. 。 』 b・ ぢ 罵 § 萎 8 。 の 。 』。 ヨ 。 。 ヨ ぢ 峯 莞 麗 ・ 窪 巴 已 慧. 8 Σ 崔 8 § 強 量 ・ 。 個 の 更. 8↑ μ . 。 。. 壼 z. ℃( § ＼ ぎ b。 ε 邸. o. 』 ) V < 。 ε 気 μ ヨ . 。 糞 蓄 亭 寸 ぎ 』 N £. ・ o. ; V 望 気 8 。 。 斎. も 。』 × コ 。 o. 璃 ・, . 。. 宕 。り £ 言 制 ゴ 君 畠 。 昌 。 N 慧.
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