Establishment of mesuring
Tetrahydrobiopterin in Develpmental Delay Patients'
Cerebrospinal Fluid
Tetrahydrobiopterin (BH4) is an endogenous factor in
human body, one of its important functions is to act as a coenzyme for certain
amino acid hydroxylases. Tetrahydrobioterin
participates in the synthesis of neurotransmitters such as dopamine and
serotonin. Deficiency in BH4 will lead to the disturbance of homeostasis of
certain amino acids
in the body, especially dopamine and serotonin, and is
called tetrahydrobiopterin deficiency (BH4 deficiency).
Tetrahydrobiopterin deficiency is one of the
Department of Health-declared rare diseases in Taiwan. Clinically, it
correlates closely with developmental delays in children Early diagnosis is
beneficial for victims. Presently, there is no analytical method applied
routinely to measure the amount of pterins in
cerebrospinal fluids in Taiwan.
The present study tried to employ and optimize
applicable analytical conditions, including buffer systems, pH value, flow
rate, and voltage (electrochemical detection), by using high-performance liquid
chromatography (HPLC) and liquid chromatography/ tandem mass spectrometry
(LC/MS-MS). The application of suitable assay methods to the measurement of
patients’ cerebrospinal fluid (CSF) samples was also attempted.
The established analytical conditions in the study are
as follows.
The first was for the simultaneous detection of neopterin and biopterin by
reversed-phase HPLC with fluorescence detector.
Chromatographic conditions were as follows: column 150
x 4.6 mm packed with 5 μm C18, mobile phase 5 mM citric buffer, pH adjusted to 5.2, flow rate 0.5 mL/min,
excitation wavelength 350 nm and emission wavelength 448 nm. The detection limit
was 200 pg.
The second was for the determination of BH4 by using
reversed-phase HPLC with electrochemical detector. Chromatographic conditions
were as follows: column 150 x 4.6 mm packed with 5 μm
C18, mobile phase 10mM phosphoric buffer, pH adjusted to 2.5, flow rate 0.4
mL/min, applied voltage was 700 mV. The detection limit was 80
pg.
The third was for the simultaneously detection of neopterin, biopterin, BH4, and
BH2 by utilizing LC/MS-MS, using reversed-phase 5 μm
C18 column (250 x 4.6 mm, I.D.) for separation. The mobile phase consisted of
5% methanol in water (pH2.5), with a flow-rate of 0.8 mL/min. The detection
limit was 1 pg.
The analytical methods described above were applied to
the assay of human CSF samples. During Nov. 10, 2004 to Dec. 31, 2005,
fifty-four patients with developmental delays were recruited into the study
from the outpatient and inpatient services of the NTUH Department
of Pediatrics. CSF samples were collected for
analysis.
Results showed that neopterin,
biopterin, BH4, and BH2 were not detectable in all
CSF samples by employing LC/MS-MS, even though our detection limit was
comparable to previous Western reports. One possible explanation is that the
CSF pterin levels of our population
was significantly lower than the Caucasian population and, thus, the
quantification was hampered by undesirable detection limit. For aiding in the
diagnosis, treatment, and monitoring of BH4 deficiency and therapy, larger-scale
trial with both healthy and diseased subjects are needed for setting up
reference values for our population in the future.