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Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children
Abstracts
analyzed using an Agilent 1290 UHPLC coupled to an Agilent 6460 triple quadrupole MS in multiple reaction monitoring mode. Results: Recovery of the four drugs from dried urine spots was assessed at three concentrations (250, 1000 and 1750 ng/mL). Our results show excellent recovery for all four drugs: desomorphine 110%, AH-7921 115%, acetyl fentanyl 110%, acetyl norfentanyl 105%. Within day precision for the four drugs ranged from 3–5% CV, dayto-day precision ranged from 6–12% CV. Conclusion: We developed a robust and accurate method that can simultaneously detect four new designer drugs (desomorphine, acetyl fentanyl, acetyl norfentanyl, AH-7921) from dried urine spots. doi:10.1016/j.clinbiochem.2015.07.067
325 Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children Laura Smya, Kaitlyn Shawb, Anne Smithb, Evan Russellc, Stan Van Uumd, Michael Riederc, Bruce Carletonb, Gideon Korene a University of Toronto/The Hospital for Sick Children, Toronto, ON, Canada b The University of British Columbia, Vancouver, BC, Canada c Western University, London, ON, Canada d St. Joseph's Health Care Centre, Toronto, ON, Canada e The Hospital for Sick Children, Toronto, ON, Canada Objectives: Asthma is the most common chronic condition in childhood and the recommended pharmacotherapy for long-term control includes the use of inhaled corticosteroids (ICS). ICS were designed to act at the site of inflammation in the lung, thus decreasing systemic absorption and reducing the risk of adverse effects associated with corticosteroid use (e.g., HPA suppression and its consequent effects). Available data show that measurement of hair cortisol successfully reflects endogenous cortisol levels. We sought to examine whether hair cortisol measurements can be used to identify HPA suppression surrounding ICS therapy in children with asthma. Design and methods: Hair samples were collected from the vertex posterior region of the head of 18 children with asthma. Hair was analyzed using a validated ELISA method (rs = 0.9, p b 0.0001, compared to two hair cortisol LC–MS methods). We compared their hair cortisol concentration during ICS use to the concentration prior to ICS use. Results: During ICS therapy, median hair cortisol levels were twofold lower compared to the period of no ICS use (median 247.7 pmol/g vs. 546.8 pmol/g, p = 0.0015). Conclusions: Hair cortisol is an effective biomarker of the HPA suppression associated with ICS therapy and can be a sensitive tool for determining systemic effects of ICS use and monitoring adherence. Future research is needed to characterize the effect of untreated asthma on hair cortisol concentrations, if any. Keywords: Asthma, Hypothalamus–pituitary–adrenal axis, Pilot study, Ciclesonide, Children doi:10.1016/j.clinbiochem.2015.07.068
326 A comprehensive database of pediatric and adult reference intervals for routine biochemical markers based on the Canadian Health Measures Survey (CHMS) Joshua Raizmana, Victoria Higginsb, Michelle Niewesteega, Yunqi Chenb, Suzy Wongc, David Blaisc, Khosrow Adelid a University of Toronto, Toronto, ON, Canada
1017
b CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada c Health Analysis Division, Statistics Canada, Ottawa, ON, Canada d Clinical Biochemistry, The Hospital for Sick Children, Toronto, ON, Canada
Objectives: The Canadian Health Measures Survey (CHMS; a program of Statistics Canada) collected comprehensive nationwide health information and biological specimens from the Canadian household population. The Canadian Laboratory Initiative for Pediatric Reference Intervals (CALIPER) collaborated with Statistics Canada to develop a robust database of reference intervals (RIs) for 24 routine chemistry biomarkers throughout life. Design and methods: Between 2007–2011, CHMS collected health information, urine, and serum from approximately 12,000 Canadians aged 3–79 years. The Ortho Vitros 5600 analyzer was used to measure 23 chemistry analytes. Using CLSI C28-A3 guidelines, exclusion criteria were applied and RIs were calculated using SAS and R. Results: Analytes were grouped into four categories based on trends: (1) Sodium, chloride, potassium, bicarbonate, albumin, total calcium, total protein, and total bilirubin remained constant throughout life. (2) Phosphate, ALKP, AST, and LDH had higher concentrations in childhood that declined with age. (3) Creatinine (serum/urine), total cholesterol, HDL, LDL, triglycerides, uric acid, and urea had higher concentrations in adulthood versus childhood. (4) GGT, ALT, and glucose showed fluctuations throughout life. Gender partitions were required except bicarbonate, total cholesterol, and total protein. Potassium showed the least variation ranging from 2.8–3.9 mmol/L across 2 age groups, while ALKP showed the most fluctuation ranging from 50–438 U/L over 5 age groups. Conclusions: This large population study highlights unique biological trends for routine biochemical markers from a cohort of healthy subjects. The RI data may be useful for clinical laboratories using Ortho chemistry assays, but should be further validated by each laboratory.
doi:10.1016/j.clinbiochem.2015.07.069
327 Pediatric and adult reference intervals for key endocrine and special chemistry markers based on the Canadian Health Measures Survey (CHMS) Joshua Raizmana, Michelle Niewesteega, Victoria Higginsb, Yunqi Chenb, Suzy Wongc, David Blaisc, Khosrow Adelid a University of Toronto, Toronto, ON, Canada b CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada c Health Analysis Division, Statistics Canada, Ottawa, ON, Canada d Clinical Biochemistry, The Hospital for Sick Children, Toronto, ON, Canada Objectives: The Canadian Laboratory Initiative for Pediatric Reference Intervals (CALIPER) has established a new reference interval (RI) database through collaboration with Statistics Canada to access data obtained through the Canadian Health Measures Survey (CHMS). Pediatric, adult, and geriatric RI for 12 endocrine and special chemistry biomarkers are presented. Design and methods: Approximately 12,000 Canadians, aged 3– 79, participated in the CHMS and provided health information including urine/serum. Biomarkers were measured using the Siemens Immulite 2000, Siemens Advia Centaur XP, Ortho Vitros 5.1 FS, or DiaSorin Liaison analyzers. Statistical analysis was performed in accordance with CLSI C28-A3 guidelines. After exclusion
analyzed using an Agilent 1290 UHPLC coupled to an Agilent 6460 triple quadrupole MS in multiple reaction monitoring mode. Results: Recovery of the four drugs from dried urine spots was assessed at three concentrations (250, 1000 and 1750 ng/mL). Our results show excellent recovery for all four drugs: desomorphine 110%, AH-7921 115%, acetyl fentanyl 110%, acetyl norfentanyl 105%. Within day precision for the four drugs ranged from 3–5% CV, dayto-day precision ranged from 6–12% CV. Conclusion: We developed a robust and accurate method that can simultaneously detect four new designer drugs (desomorphine, acetyl fentanyl, acetyl norfentanyl, AH-7921) from dried urine spots. doi:10.1016/j.clinbiochem.2015.07.067
325 Hair cortisol as a novel biomarker of HPA suppression by inhaled corticosteroids in children Laura Smya, Kaitlyn Shawb, Anne Smithb, Evan Russellc, Stan Van Uumd, Michael Riederc, Bruce Carletonb, Gideon Korene a University of Toronto/The Hospital for Sick Children, Toronto, ON, Canada b The University of British Columbia, Vancouver, BC, Canada c Western University, London, ON, Canada d St. Joseph's Health Care Centre, Toronto, ON, Canada e The Hospital for Sick Children, Toronto, ON, Canada Objectives: Asthma is the most common chronic condition in childhood and the recommended pharmacotherapy for long-term control includes the use of inhaled corticosteroids (ICS). ICS were designed to act at the site of inflammation in the lung, thus decreasing systemic absorption and reducing the risk of adverse effects associated with corticosteroid use (e.g., HPA suppression and its consequent effects). Available data show that measurement of hair cortisol successfully reflects endogenous cortisol levels. We sought to examine whether hair cortisol measurements can be used to identify HPA suppression surrounding ICS therapy in children with asthma. Design and methods: Hair samples were collected from the vertex posterior region of the head of 18 children with asthma. Hair was analyzed using a validated ELISA method (rs = 0.9, p b 0.0001, compared to two hair cortisol LC–MS methods). We compared their hair cortisol concentration during ICS use to the concentration prior to ICS use. Results: During ICS therapy, median hair cortisol levels were twofold lower compared to the period of no ICS use (median 247.7 pmol/g vs. 546.8 pmol/g, p = 0.0015). Conclusions: Hair cortisol is an effective biomarker of the HPA suppression associated with ICS therapy and can be a sensitive tool for determining systemic effects of ICS use and monitoring adherence. Future research is needed to characterize the effect of untreated asthma on hair cortisol concentrations, if any. Keywords: Asthma, Hypothalamus–pituitary–adrenal axis, Pilot study, Ciclesonide, Children doi:10.1016/j.clinbiochem.2015.07.068
326 A comprehensive database of pediatric and adult reference intervals for routine biochemical markers based on the Canadian Health Measures Survey (CHMS) Joshua Raizmana, Victoria Higginsb, Michelle Niewesteega, Yunqi Chenb, Suzy Wongc, David Blaisc, Khosrow Adelid a University of Toronto, Toronto, ON, Canada
1017
b CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada c Health Analysis Division, Statistics Canada, Ottawa, ON, Canada d Clinical Biochemistry, The Hospital for Sick Children, Toronto, ON, Canada
Objectives: The Canadian Health Measures Survey (CHMS; a program of Statistics Canada) collected comprehensive nationwide health information and biological specimens from the Canadian household population. The Canadian Laboratory Initiative for Pediatric Reference Intervals (CALIPER) collaborated with Statistics Canada to develop a robust database of reference intervals (RIs) for 24 routine chemistry biomarkers throughout life. Design and methods: Between 2007–2011, CHMS collected health information, urine, and serum from approximately 12,000 Canadians aged 3–79 years. The Ortho Vitros 5600 analyzer was used to measure 23 chemistry analytes. Using CLSI C28-A3 guidelines, exclusion criteria were applied and RIs were calculated using SAS and R. Results: Analytes were grouped into four categories based on trends: (1) Sodium, chloride, potassium, bicarbonate, albumin, total calcium, total protein, and total bilirubin remained constant throughout life. (2) Phosphate, ALKP, AST, and LDH had higher concentrations in childhood that declined with age. (3) Creatinine (serum/urine), total cholesterol, HDL, LDL, triglycerides, uric acid, and urea had higher concentrations in adulthood versus childhood. (4) GGT, ALT, and glucose showed fluctuations throughout life. Gender partitions were required except bicarbonate, total cholesterol, and total protein. Potassium showed the least variation ranging from 2.8–3.9 mmol/L across 2 age groups, while ALKP showed the most fluctuation ranging from 50–438 U/L over 5 age groups. Conclusions: This large population study highlights unique biological trends for routine biochemical markers from a cohort of healthy subjects. The RI data may be useful for clinical laboratories using Ortho chemistry assays, but should be further validated by each laboratory.
doi:10.1016/j.clinbiochem.2015.07.069
327 Pediatric and adult reference intervals for key endocrine and special chemistry markers based on the Canadian Health Measures Survey (CHMS) Joshua Raizmana, Michelle Niewesteega, Victoria Higginsb, Yunqi Chenb, Suzy Wongc, David Blaisc, Khosrow Adelid a University of Toronto, Toronto, ON, Canada b CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada c Health Analysis Division, Statistics Canada, Ottawa, ON, Canada d Clinical Biochemistry, The Hospital for Sick Children, Toronto, ON, Canada Objectives: The Canadian Laboratory Initiative for Pediatric Reference Intervals (CALIPER) has established a new reference interval (RI) database through collaboration with Statistics Canada to access data obtained through the Canadian Health Measures Survey (CHMS). Pediatric, adult, and geriatric RI for 12 endocrine and special chemistry biomarkers are presented. Design and methods: Approximately 12,000 Canadians, aged 3– 79, participated in the CHMS and provided health information including urine/serum. Biomarkers were measured using the Siemens Immulite 2000, Siemens Advia Centaur XP, Ortho Vitros 5.1 FS, or DiaSorin Liaison analyzers. Statistical analysis was performed in accordance with CLSI C28-A3 guidelines. After exclusion