Mass Spectrometry Application Strategies of Dried Blood Spots Analysis

El análisis de manchas de sangre seca (DBS) es una tecnología de análisis bien conocida, cuyas primeras aplicaciones de rutina se remontan a la década de 1960. Los avances en los instrumentos de espectrometría de masas durante el siglo pasado, permitieron alcanzar la sensibilidad necesaria para abrir nuevos mercados. Sin embargo, algunas incertidumbres y la falta de comprensión de los métodos han impedido hasta el momento que la tecnología tenga una amplia aceptación en el mercado.En esta tesis doctoral se han desarrollado y validado diversas técnicas, condiciones y flujos de trabajo de análisis DBS, que demuestran la viabilidad y el potencial de aplicación de la tecnología DBS-LC-MS.Se han desarrollado métodos avanzados para su aplicación en el campo de la pediatría neonatal, en particular la prueba del talón en recién nacidos, donde se ha ampliado y estandarizado el panel de análisis.También se han investigado nuevos campos de aplicación, como la vigilancia de medicamentos terapéuticos y la toxicología forense. Se describe la aplicación de la farmacovigilancia remota de antirretrovirales en regiones de escasos recursos y se presentan nuevos enfoques analíticos para la vigilancia del abuso de alcohol. Finalmente, en esta tesis se ha introducido un método innovador con el que se pueden detectar más de 1.200 drogas ilícitas a partir de una sola gota de sangre.La investigación científica realizada se presenta en forma de compendio de publicaciones (6), que son incluidas en esta Memoria. Se adjuntan a modo de apéndice otros dos trabajos del candidato que no constan oficialmente en dicho compendio. Todos los trabajos constituyen una unidad temática coherente sobre la técnica de la DBS y su acoplamiento a la espectrometría de masas.This doctoral thesis is a compendium of dried blood spot (DBS) applications in the fields of newborn screening, forensic toxicology and therapeutic drug monitoring. DBS is a well-known analysis technology, which first routine applications date back to the 1960s. Advancements in mass spectrometry instruments during the last century, enabled to reach the required sensitivity to open up new markets. Some uncertainties and missing method understanding remain and this is holding back the technology from wide spread market acceptance. For the general scientific acceptance of this technology, several methods have been developed and validated within this work. Advanced methods for the field of newborn screening were developed, where the analysis panel has been extended and standardized. Goal of the first study was to transfer the amino acids and acyl carnitines analysis onto the automated DBS-MS 500 platform. Also, a steroid panel of 17OHP, cortisol and androstenedione was defined to exclude the 17OHP from the immune assay panel and to transfer this as well onto the fully automated DBS-LC-MS/MS. The conventional 17OHP enzyme-linked immunosorbent assay (ELISA) based on a manually punched DBS disc leads to a high percentage of false positive. First, cortisol increases when the babies are stressed, which also leads to elevated 17OHP concentrations and secondly, the ELISA has significant cross reaction potential with steroid sulfate which can be monitored with androstenedione. Both, the amino acid and acyl carnitine detection plus the integration of a steroid panel into the DBS-LC-MS/MS workflow was successfully achieved [1]. Newborn screening panels are not unified across borders and sometimes even differ within countries and laboratories. The implementation of the fully automated DBS platform could be a good starting point of standardization and unification of those programs. Here, a method based on an official newborn screening kit was introduced within this thesis. The analysis takes only 2 minutes per sample; however it is limited to amino acids and acyl carnitines only. The DBS extract is directly guided to the mass spectrometer without any column. This is a well-known procedure in newborn screening and allows speeding up the process to its optimum [2]. Therapeutic drug monitoring, especially in remote and rural areas is another upcoming application field of DBS. Several methods have been supported and co-authored, whereas the first method focuses of the three antiretroviral drugs nevirapine, efavirenz and lopinavir. The study highlights the transportation advantages of DBS, without any biohazard labeling neither requiring cooling chains. DBS were drawn in Tanzania, Africa, and sent to Switzerland where the samples went through different climate zones. Nonetheless, the samples showed very good results and stability of the monitored drugs [3]. We ran a follow up study on some of the samples approximately one year after the publication, where still all analytes could be recovered in the same concentration as published. Also the DBS sampling itself was investigated in a rural area of Tanzania [4] and the technique proved to be suitable. Another therapeutic drug, where a more efficient sampling process is required for mass drug administration (MDA) campaigns, is Ivermectin. This drug lowers the incidence of river blindness and lymphatic filariasis infections. Further, recent studies demonstrated that Ivermectin is also active against several other parasites and even against certain mosquitoes. As one of these mosquitoes is Anopheles gambiae, the major vector of malaria in Africa, Ivermectin could be mass administered to fight malaria. In other words, the drug makes the human blood lethal for the Anopheles gambiae and therefore reduces the number of vectors in an area. Still, more safety data is required from a larger population. Here, an according fully automated DBS method has been developed and validated. In addition, a comparison study to plasma samples, stability and hematocrit impact has been studied [5]. In forensic toxicology, it was shown that Dried Matrix Spot (DMS) is a suitable technology for large scale DBS applications. A fully automated method, where either 1200 drugs can be screened from a DBS and a quantitative follow up method focusing on the 28 most abundant drugs of abuse, was developed. This was documented within two publications, where the first publication was a proof of concept study to determine if the detection limits can be reached using the DBS-LC-MS/MS methodology [6]. The second, follow up publication was a specific method development and implementation. More than 1200 illicit drugs can be screened from a single DBS or Dried Urine Spots (DUS) within 20 minutes per sample using a Forensic Toxicology Database. The criteria of bio-analytical method validation guidelines were fulfilled, and the method was transferred into a routine laboratory successfully [7]. Furthermore, the discovery of phosphatidylethanol (PEth) as direct alcohol marker prolonged the window of detection for alcohol consumption to several weeks. PEth proved to be instable during storage of liquid blood samples. By using DBS sampling, this biomarker can be stabilized due to the inactivation of enzymatic activity. Also, for PEth, a fully automated DBS-LC-MS/MS was established for the determination of the two most abundant PEth homologs in a range from 20–1500 ng/mL. Automated DBS card handling and online solid phase extraction LC-MS/MS permits baseline separation and detection of PEth 16:0/18:1 and PEth 16:0/18:2 within 7 minutes per sample [8]. The methods from the various fields of application were presented at several conferences as oral presentations and posters, showing their interest from the scientific blood analysis community.<br /

Fully automated dried blood spot sample handling and extraction for BoHV-1 antibody testing by ELISA

This study is the first proof of concept of the DBS technology for Bovine alphaherpesvirus 1 (BoHV-1) antibody detection by ELISA after fully automated DBS extraction. DBS were prepared from nine BoHV-1 seropositive plasma samples spiked with erythrocytes. Spots were extracted automatically on a DBS-MS 500 HCT autosampler, as well as manually using a 3.2 mm puncher. DBS were equally prepared from 20 bovine seronegative EDTA-blood samples and extracted automatically. Extracts were tested in a commercial BoHV-1 antibody ELISA and results were compared with those from liquid plasma. Eight seropositive DBS samples were additionally tested in the ELISA after storage for four weeks at different conditions. After automated extraction all DBS samples yielded qualitatively correct results and were in full accordance with those obtained from liquid plasma. Automated extraction using a 6 mm extraction head was more sensitive than a 4 mm head. Stability of DBS was highest at - 20 °C and decreased with increasing temperature. Even after four weeks at 37 °C, most seropositive samples yielded a positive result in the ELISA. The minimal invasiveness, biosafety, and simplicity of DBS collection together with automated extraction represents an interesting, high-throughput compatible alternative to liquid blood samples for BoHV-1 monitoring or eradication programs

On the complex relationship between resilience and hair cortisol levels in adolescence despite parental physical abuse: a fourth wave of resilience research

IntroductionTo understand the family’s role in adolescents’ mental health development and the connection to neurodevelopmental disorders related to experienced parental physical abuse, we first explored resilience pathways longitudinally and secondly, connected the identified patterns to adolescents’ hair cortisol levels that are rooted in the hypothalamic–pituitary–adrenal axis as the main stress response system and connected brain structure alterations.MethodsWe analyzed longitudinal online questionnaire data for three consecutive high school years (from seventh to ninth grade) and four survey waves from a representative sample of n = 1609 high school students in Switzerland on violence–resilience pathways. Furthermore, we collected students’ hair samples from a subsample of n = 229 at survey wave 4. About 30% of the participating adolescents had been physically abused by their parents. Out of the overall sample, we drew a subsample of adolescents with parental abuse experiences (survey wave 1 n = 509; survey wave 2 n = 506; survey wave 3 n = 561; survey wave 4 n = 560).ResultsDespite the odds, about 20–30% of adolescents who have experienced parental physical abuse escaped the family violence cycle and can be called resilient. By applying a person-oriented analytical approach via latent class and transition analysis, we longitudinally identified and compared four distinct violence–resilience patterns. We identified violence resilience as a multidimensional latent construct, which includes hedonic and eudaimonic protective and risk indicators. Because resilience should not solely be operationalized based on the lack of psychopathology, our latent construct included both feeling good (hedonic indicators such as high levels of self-esteem and low levels of depression/anxiety and dissociation) and doing well (eudaimonic indicators such as high levels of self-determination and self-efficacy as well as low levels of aggression toward peers).DiscussionThe present study confirmed that higher cortisol levels significantly relate to the comorbid pattern (internalizing and externalizing symptoms), and further confirmed the presence of lasting alterations in brain structures. In this way, we corroborated the insight that when studying the resilience pathways and trajectories of abused adolescents, biological markers such as hair cortisol significantly enhance and deepen the understanding of the longitudinal mechanisms of psychological markers (e.g., self-determination, self-esteem, self-efficacy) that are commonly applied in questionnaires

Influence of soil on the efficacy of entomopathogenic nematodes in reducing Diabrotica virgifera virgifera in maize

The use of entomopathogenic nematodes is one potential non-chemical approach to control the larvae of the invasive western corn rootworm (Diabrotica virgifera virgifera LeConte, Coleoptera: Chrysomelidae) in Europe. This study investigated the efficacy of Heterorhabditis bacteriophora Poinar (Rhabditida: Heterorhabditidae), Heterorhabditis megidis Poinar, Jackson and Klein (Rh., Heterorhabditidae) and Steinernema feltiae Filipjev (Rh., Steinernematidae) in reducing D. v. virgifera as a function of soil characteristics. A field experiment was repeated four times in southern Hungary using artificially infested maize plants potted into three different soils. Sleeve gauze cages were used to assess the number of emerging adult D. v. virgifera from the treatments and untreated controls. Results indicate that nematodes have the potential to reduce D. v. virgifera larvae in most soils; however, their efficacy can be higher in maize fields with heavy clay or silty clay soils than in sandy soils, which is in contrast to the common assumption that nematodes perform better in sandy soils than in heavy soils

A genetic investigation of sex bias in the prevalence of attention-deficit/hyperactivity disorder

Background Attention-deficit/hyperactivity disorder (ADHD) shows substantial heritability and is 2-7 times more common in males than females. We examined two putative genetic mechanisms underlying this sex bias: sex-specific heterogeneity and higher burden of risk in female cases. Methods We analyzed genome-wide autosomal common variants from the Psychiatric Genomics Consortium and iPSYCH Project (20,183 cases, 35,191 controls) and Swedish populationregister data (N=77,905 cases, N=1,874,637 population controls). Results Genetic correlation analyses using two methods suggested near complete sharing of common variant effects across sexes, with rg estimates close to 1. Analyses of population data, however, indicated that females with ADHD may be at especially high risk of certain comorbid developmental conditions (i.e. autism spectrum disorder and congenital malformations), potentially indicating some clinical and etiological heterogeneity. Polygenic risk score (PRS) analysis did not support a higher burden of ADHD common risk variants in female cases (OR=1.02 [0.98-1.06], p=0.28). In contrast, epidemiological sibling analyses revealed that the siblings of females with ADHD are at higher familial risk of ADHD than siblings of affected males (OR=1.14, [95% CI: 1.11-1.18], p=1.5E-15). Conclusions Overall, this study supports a greater familial burden of risk in females with ADHD and some clinical and etiological heterogeneity, based on epidemiological analyses. However, molecular genetic analyses suggest that autosomal common variants largely do not explain the sex bias in ADHD prevalence

Mass spectrometry application strategies of dried blood spots analysis

121 pags.-- Figuras,Tablas,Fotos.-- Tesis doctoral llevada a cabo para conseguir el grado de Doctor en la Universidad de Zaragoza.-- Lectura de la tesis: 19-09-2019.-- Sobresaliente "cum laude", con mención internacional.[EN] Dried blood spot analysis (DBS) is a well-known analysis technology, which first routine applications date back to the 1960s. Advancements in mass spectrometry instruments during the last century, enabled to reach the required sensitivity to open up new markets. Some uncertainties and missing method understanding remain and this is holding back the technology from wide spread market acceptance. In this doctoral thesis, various DBS analysis techniques, conditions and workflows have been developed and validated, demonstrating the feasibility and application of the DBS-LC-MS technology. Advanced methods for the field of newborn screening were developed, where the analysis panel has been extended and standardized. Also new fields of application, such as therapeutic drug monitoring and forensic toxicology were investigated. Drug monitoring of antiretroviral drugs in remote and resource poor regions are described and new approaches for alcohol abuse monitoring are presented. Finally, a breakthrough method, where over 1200 illicit drugs can be detected from one single blood droplet, was introduced within this thesis. The scientific research carried out is presented in the form of a compendium of publications (6), which are included in this report. Two other works of that do not appear officially in this compendium, are attached as an appendix. All the works constitute a coherent thematic unit on the technique of the DBS and its coupling to the mass spectrometry.[ES] El análisis de manchas de sangre seca (DBS) es una tecnología de análisis bien conocida, cuyas primeras aplicaciones de rutina se remontan a la década de 1960. Los avances en los instrumentos de espectrometría de masas durante el siglo pasado, permitieron alcanzar la sensibilidad necesaria para abrir nuevos mercados. Sin embargo, algunas incertidumbres y la falta de comprensión de los métodos han impedido hasta el momento que la tecnología tenga una amplia aceptación en el mercado. En esta tesis doctoral se han desarrollado y validado diversas técnicas, condiciones y flujos de trabajo de análisis DBS, que demuestran la viabilidad y el potencial de aplicación de la tecnología DBS-LC-MS. Se han desarrollado métodos avanzados para su aplicación en el campo de la pediatría neonatal, en particular la prueba del talón en recién nacidos, donde se ha ampliado y estandarizado el panel de análisis. También se han investigado nuevos campos de aplicación, como la vigilancia de medicamentos terapéuticos y la toxicología forense. Se describe la aplicación de la farmacovigilancia remota de antirretrovirales en regiones de escasos recursos y se presentan nuevos enfoques analíticos para la vigilancia del abuso de alcohol. Finalmente, en esta tesis se ha introducido un método innovador con el que se pueden detectar más de 1.200 drogas ilícitas a partir de una sola gota de sangre. La investigación científica realizada se presenta en forma de compendio de publicaciones (6), que son incluidas en esta Memoria. Se adjuntan a modo de apéndice otros dos trabajos del candidato que no constan oficialmente en dicho compendio. Todos los trabajos constituyen una unidad temática coherente sobre la técnica de la DBS y su acoplamiento a la espectrometría de masas.Peer reviewe

Automated High-Throughput Analysis of Tramadol and O-Desmethyltramadol in Dried Blood Spots.

The World Anti-Doping Agency (WADA) and the International Testing Agency (ITA) recently announced the development and implementation of dried blood spot (DBS) testing for routine analysis in time for the 2022 Winter Olympic and Paralympic Games in Beijing. Following the introduction of a ban on the use of Tramadol in competition in March 2019, the Union Cycliste International (UCI) started a pilot study for the manual analysis of Tramadol in DBS for anti-doping purposes. In this context, we present a fully automated LC-MS/MS-based method with automated sample preparation using a CAMAG DBS-MS 500 for the analysis of tramadol and its metabolite O-desmethyltramadol in DBS. The presented approach reduces manual handling in the laboratory to an absolute minimum, only requiring the preparation of calibration and quality control DBS cards. The method was developed, optimized, and validated before performing cross-validation with a liquid blood-based analysis method using authentic samples from forensic cases. During the validation process, the method showed an extraction efficiency of 62%, linearity r2 >0.99, accuracy and precision (within ±15% and ±20% at the LLOQ) for the determination of tramadol and O-desmethyltramadol. Method comparison in liquid blood with 26 samples showed good agreement (90±19% for tramadol and 94±14% for O-desmethyltramadol). In conclusion, automated analysis of tramadol and O-desmethyltramadol in DBS provides a fast and accurate solution for anti-doping screening. It is suited for high-throughput analysis, having a run time of about 4 min per sample. Furthermore, with the automated approach, manual sample extraction becomes obsolete

Fully Automated Determination of Phosphatidylethanol 16:0/18:1 and 16:0/18:2 in Dried Blood Spots.

PURPOSE Direct alcohol markers are widely applied during abstinence monitoring, driving aptitude assessments and workplace drug testing. The most promising direct alcohol marker was found to be phosphatidylethanol (PEth). Compared to other markers it shows a long window of detection due to accumulation in blood. To facilitate and accelerate the determination of PEth in DBS, we developed a fully automated analysis approach. METHODS The validated and novel online-SPE-LC-MS/MS method with automated sample preparation using a CAMAG DBS-MS 500 system reduces manual sample preparation to an absolute minimum, only requiring calibration and quality control DBS. RESULTS During the validation process, the method showed a high extraction efficiency (>88%), linearity (correlation coefficient >0.9953), accuracy and precision (within ±15%) for the determination of PEth 16:0/18:1 and PEth 16:0/18:2. Within a run time of about 7 min, the two monitored analogs could be baseline separated. A method comparison in liquid whole blood of 28 authentic samples from alcohol use disorder patients showed a mean deviation of less than 2% and a correlation coefficient of >0.9759. The comparison with manual DBS extraction showed a mean deviation of less than 8% and a correlation coefficient of >0.9666. CONCLUSIONS The automated analysis of PEth in DBS can provide a fast and accurate solution for abstinence monitoring. In contrast to the manual extraction of PEth in DBS, no laborious sample preparation is required with this automated approach. Furthermore, the application of the internal standard by a spray module can compensate for extraction bias and matrix effects