Method Article
This method involves extracting retinol from serum, separating it using HPLC, and determining labeled and non-labeled retinol isotopes using GC-MS. The ratio of labeled to non-labeled retinol is used to estimate total body stores of vitamin A.
This method describes the determination of deuterium enrichment of retinol in serum and the estimation of vitamin A stores in the body. The process involves extracting retinol from 0.4 mL of serum using 0.5 mL of 0.85% saline solution, 100 µL of internal standard solution, and 5 mL of chloroform-methanol (2:1 v/v) solution. After centrifugation and removal of the lower chloroform layer, the mixture is dried under nitrogen and resuspended in 0.1 mL of ethanol, and the retinol fraction is separated from other constituents using an HPLC system equipped with a PE C18 column. The retinol fraction can be collected manually or with a fraction collector. Subsequently, the retinol fraction is dried under nitrogen and derivatized with O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) containing 10% trimethylchlorosilane. Finally, labeled and non-labeled retinol isotopes are quantified using a GC-MS system equipped with a 19091z-431 HP-1 methyl siloxane capillary column, employing electron capture negative chemical ionization with helium as the carrier gas and methane as the ionization agent. The ratio of labeled to non-labeled retinol is then used in the Olson, Green, or mass balance equations to estimate vitamin A stores.
Vitamin A is an essential nutrient needed for the visual system and maintenance of cell function for growth, epithelial integrity, red blood cell production, immunity, and reproduction1. Vitamin A deficiency is a serious public health problem worldwide, affecting more than 100 countries. It disproportionately impacts young children and pregnant women in low-income countries. Approximately 190 million children globally suffer from vitamin A deficiency, making it a critical issue for public health and child development2.
In response to this situation, several programs, including vitamin A supplementation with biannual distribution of high doses of vitamin A to children under 5 years of age and vitamin A fortification of certain food commodities, have been implemented for decades in many low-income countries. However, these interventions often overlap, exposing some populations to inadvertent chronic excessive vitamin A intake3,4. This dual risk of deficiency and excess highlights the need for a biomarker that can accurately assess vitamin A status across the full spectrum, from deficiency to toxicity, to guide program evaluation.
Vitamin A biomarkers are crucial for assessing nutritional status. The most commonly used biomarkers are serum concentrations of retinol and retinol-binding protein (RBP). However, it's important to note that these biomarkers can be temporarily suppressed by infections and inflammation, which may lower the specificity of vitamin A assessments in certain populations5,6,7.
While liver biopsy or autopsy samples are considered the gold standard for assessing vitamin A status, the most sensitive indirect indicator of total liver vitamin A reserves is the retinol isotope dilution (RID) method8. RID provides a quantitative estimate of vitamin A status across the full spectrum, ranging from deficient to excessive stores9. In most research applications, the RID method involves administering an oral dose of deuterium (2H) or 13C-labeled retinyl acetate, which then mixes with body stores over a period of 14 to 21 days. After this period, a blood sample is collected, and the serum is stored at -80 °C. The ratio of labeled to total retinol is then analyzed using mass spectrometry to estimate vitamin A stores10, employing the Olson equation11, the mass-balance equation12, or the Green equation13. The protocol presented in this paper is valid for the administration of deuterium (2H)- or 13C-labeled retinyl acetate and is based on the work of Tang et al.14. The overall goal of this method is to accurately assess and monitor vitamin A status in the body11. It is a powerful method that provides a quantitative estimate of vitamin A concentrations across a broad spectrum of statuses, from deficiency to excess15. It is more accurate and precise than other methods, which often rely on indirect measures9.
The protocol was approved by the Ethics Committee of the Ministry of Public Health (No. 2015/02/550/CE/CNERSH/SP), and informed consent was obtained from parents/guardians.
NOTE: Because vitamin A is light-sensitive, it is crucial that all procedures be conducted in dim light or under gold fluorescent lighting16. The materials used are detailed in Table of Materials.
1. Preparation of reagents
2. Preparation of standard solutions
3. Sample analysis
NOTE: The serum samples used in this study were collected on the 14th day from children who received an oral dose (2 mg retinol equivalents) of D8-retinol as part of a study designed to monitor and assess the vitamin A status of children in Cameroon.
4. Data analysis
5. Estimation of vitamin A stores
NOTE: This step allows for the assessment of an individual's vitamin A status.
The injection of 3 µL of a derivatized sample of a dried solution containing approximately 50 pM/µL of calibrants (retinol and D8-retinol) into the GC/MS showed no molecular ion but exhibited a major fragment ion at m/z 268 for retinol (Figure 1) and m/z 278 for D8-retinol (Figure 2). This indicates that the molecular ions of retinyl trimethylsilyl ether, formed during the derivatization of retinol and D8-retinol, are not stable under the ionization conditions used in GC/MS. They break down into smaller fragments, primarily through alpha cleavage. This common fragmentation pattern involves the breaking of the bond adjacent to the trimethylsilyl ether group. The alpha cleavage results in the loss of the trimethylsilyl group (TMS, which has a mass of 73 Da) and a hydrogen atom, leading to a fragment ion with a mass of 268 Da for retinol and 278 Da for D8-retinol22. This mechanism helps in identifying and confirming the presence of retinol and its derivatives in the sample by analyzing the specific fragment ions produced during mass spectrometry. Injection of mixtures of retinol and D8-retinol showed two major fragment ions at m/z 268 for retinol and m/z 276 for D8-retinol (Figure 3), indicating the presence of these compounds in the sample. The calibration curve exhibited excellent linearity, as indicated by a high correlation coefficient (Figure 4), showing that the relationship between peak ratio and weight ratio has a very straight and predictable pattern.
The GC/MS response obtained from the injections of serum samples (serum from children who received an oral dose of 2 mg retinol equivalents of D8-retinol; Figure 5) shows the presence of retinol and D8-retinol, with the two major fragment ions observed at m/z 268 and m/z 274. Results obtained after extraction of ions and integration of peak areas at m/z 274, 275, 276, 277, and 278 for D8-retinol and at m/z 268, 269, and 270 for unlabeled retinol are presented in Table 5. These results are to be integrated into the Olson equation11 or the Green equation13 to calculate vitamin A stores in the body.
The stable isotope dilution technique provides measurements of vitamin A levels that cannot be obtained by other methods, enabling accurate assessments of vitamin A status. This method is valuable for nutritional studies, clinical diagnostics, and epidemiological research.
Figure 1: Chromatogram and mass spectrum of retinol. The figure shows the gas chromatography/methane electron capture negative chemical ionization-mass spectrometry chromatogram (top panel) from the analysis of the derivatized retinol standard. The bottom panel is a mass spectrum showing m/z 268 for retinol. Please click here to view a larger version of this figure.
Figure 2: Chromatogram and mass spectrum of D8-retinol. The figure shows the gas chromatography/methane electron capture negative chemical ionization-mass spectrometry chromatogram (top panel) from the analysis of the derivatized D8-retinol standard. The bottom panel is a mass spectrum showing m/z 278 for D8-retinol. Please click here to view a larger version of this figure.
Figure 3: Chromatogram and mass spectrum of a retinol and D8-retinol mixture. The figure shows the gas chromatography/methane electron capture negative chemical ionization-mass spectrometry chromatogram (top panel) from the analysis of a derivatized mixture of retinol and D8-retinol standards. The bottom panel is a mass spectrum showing m/z 268 for retinol and m/z 276 for D8-retinol. Please click here to view a larger version of this figure.
Figure 4: Calibration curve. This figure illustrates the relationship between the GC/MS response and the concentration of unlabeled and labeled retinol. It is described by the equation y = 9.8379x + 0.7019, where y (the area ratios) represents the instrument response, 9.8379 is the sensitivity, x (the weight ratios) represents the analyte concentration, and 0.7019 is the background signal. Please click here to view a larger version of this figure.
Figure 5: Chromatogram and mass spectrum of serum sample. This figure illustrates the gas chromatography/methane electron capture negative chemical ionization-mass spectrometry chromatogram (top panel) from the analysis of the derivatized retinol fraction of serum. The bottom panel is a mass spectrum showing m/z 274 for D8-retinol. Please click here to view a larger version of this figure.
Standard | Weight (mg) | Volumetric flask (mL) | Solvent |
Retinol | 40 | 100 | Ethanol |
Retinyl acetate | 40 | 100 | Ethanol |
Deuterium-labeled retinyl acetate | 40 | 100 | Ethanol |
Table 1: Preparation of stock solution. This table demonstrates how to prepare concentrated solutions of retinol and deuterium-labeled retinyl acetate, which can then be diluted to lower concentrations for future experiments.
Standard | Stock solution (mL) | Volumetric flask (mL) | Solvent |
Retinol | 1 | 50 | Ethanol |
Retinyl acetate | 1 | 50 | Ethanol |
Deuterium-labeled retinyl acetate | 1 | 50 | Ethanol |
Table 2: Preparation of diluted stock solutions. This table demonstrates how to prepare ready-to-use solutions of retinol and deuterium-labeled retinyl acetate.
Standard | Wavelength (nm) | E1%1 cm |
Retinol | 325 | 1850 |
Retinyl acetate | 326 | 1550 |
Table 3: Wavelength and E1% 1 cm (Absorption coefficient).
Time (min) | Flow (mL/min) | Mobile Phase A (%) | Mobile Phase B (%) |
0 – 6 | 1 | 100 | 0 |
6 – 13 | 1 | 100 → 50 | 0 → 50 |
13 - 18 | 1 | 50 | 50 |
18 - 20 | 1 | 50 → 0 | 50 → 100 |
20 - 28 | 1 | 0 | 100 |
28 - 29 | 1 | 0 → 100 | 100 → 0 |
Table 4: Time schedule for HPLC mobile phases. This table illustrates the planned sequence and duration of different phases during the HPLC chromatographic run.
SH | SD | D | H | |
Subject 1 | 64030809 | 566089.7 | 0.008763 | 0.991237 |
Subject 2 | 194354 | 43861.39 | 0.184125 | 0.815875 |
Subject 3 | 793490 | 80179.28 | 0.091773 | 0.908227 |
Subject 4 | 2002063 | 45286.7 | 0.02212 | 0.97788 |
Subject 5 | 80999193 | 355980.7 | 0.004376 | 0.995624 |
Subject 6 | 32196717.7 | 216152.7 | 0.006669 | 0.993331 |
Subject 7 | 40905724.5 | 334818.1 | 0.008119 | 0.991881 |
Subject 8 | 28336711.5 | 218924.1 | 0.007667 | 0.992333 |
Subject 9 | 8695135.5 | 542077 | 0.058684 | 0.941316 |
Subject 10 | 103260212 | 1717728 | 0.016363 | 0.983637 |
SH: sum of peak area at m/z 268, 269 and 270 | ||||
SD: sum of peak area at m/z 274, 275, 276, 277 and 278 | ||||
D: enrichment of labeled retinol | ||||
H: level of unlabeled retinol |
Table 5: Results of GC/MS of derivatized retinol fraction of serum. This table reports GC/MS outputs needed for the calculation of vitamin A total body store. H is the sum of the peak area at m/z 268, 269, and 270; D is the sum of the peak area at m/z 274, 275, 276, 277, and 278; D is the enrichment of labeled retinol; H is the level of unlabeled retinol; TBS is vitamin A Total Body Store.
The successful implementation of this protocol relies on the effective execution of each step. Proper preparation of solutions and standards is crucial to ensure that the data collected is accurate and reliable. The procedures described in the protocol were tested in various settings and are suitable for obtaining solutions and standards that meet the objectives of sample analysis.
The analysis of samples starts with the extraction and separation of retinol in the serum. Storing serum samples at -80 °C until analysis is essential to prevent the degradation of vitamin A. Additionally, working in dim light is necessary16. The HPLC procedure used to collect the retinol fraction is designed to separate retinol from other fat-soluble components to avoid interference in the derivatization process. It also allows running hundreds of samples without flushing the column.
The retinol fraction collected from HPLC is derivatized with BSTFA at 70 °C for 30 min. The derivatization step is critical for improving the volatility of retinol and its detectability in GC-MS. Since it is sensitive to water, it is crucial to completely dry the sample before derivatization and to allow sufficient time for the derivatization reaction to occur before GC-MS analysis. It was noticed that the derivatization process with BSTFA is very mild and efficient compared to the one using N-methyl-N-(tert-butyldimethylsilyl) trifluoroacetamide (MTBSTFA)23,24 and provides a very sharp peak for derivatized retinol, with no tailing or background peaks in the scanned mass range14. Derivatized retinol in a sealed vial can be kept in a desiccator at 4 °C for 1 month without degradation14.
For the GC-MS analysis, it is critical to ensure proper calibration and maintenance of the column, and to optimize the injection volume, temperature, and flow rates. The conditions used here with on-column injection showed good and reliable results14. During GC-MS analysis of deuterated and unlabeled retinol, Tang et al.14 observed that the peaks of deuterated retinol appeared both in the administered dose and in the serum of subjects who received the dose. This pattern was not seen with unlabeled retinol. Therefore, they concluded that the peaks of deuterated retinol are pre-formed in the dose and not a result of fragmentation in the mass spectrometer, suggesting that the deuterated retinol maintains its structure through the metabolic process, providing a reliable marker for tracking retinol in biological studies. The enrichment of deuterated retinol in serum after the administration of 2 mg of D8-retinol in preschool-age children began to increase at 7 h and reached its peak at 14 days, which is the shorter optimal sampling time25. In 200 µL of human serum, the minimum detectable percent enrichment of retinol is 0.01%, demonstrating that the method is sensitive enough to analyze serum samples collected from subjects with a wide range of vitamin A statuses14.
While the stable isotope dilution technique presented here offers significant advantages for assessing vitamin A status, it should be noted that this method requires sophisticated equipment and technical expertise, making it expensive and less accessible for routine use in many settings26. Therefore, it is essential to consider this limitation when planning to use this technique.
This manuscript is part of a series entitled Utilizing the Retinol Isotope Dilution Method for Assessing Vitamin A Body Stores and Liver Vitamin A Concentration supported by IAEA.
We learned this protocol during a fellowship at the Carotenoids and Health Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA, under the supervision of Guangwen Tang and with the financial support of the International Atomic Energy Agency (IAEA).
Name | Company | Catalog Number | Comments |
13x100 mm disposable culture tubes | 99445-13 | PYREX Disposable Rimless Culture Tubes | |
16x100 mm disposable culture tubes | 99445-16 | PYREX Disposable Rimless Culture Tubes | |
24 Position N-EVAP Nitrogen Evaporator | Organomation Associates, Inc | 11250 | N-EVAP 112, Nitrogen Evaporator, with OA-SYS heating system |
Acetonitrile | Sigma-Aldrich | 00687 | Acetonitrile, suitable for HPLC, gradient grade, ≥99.9% |
Amber colored Crimp vials, 2 mL, | SU860033 | Short thread autosampler vial, amber vial 11.6 x 32 mm | |
Analytical Balance | Mettler Toledo | 30133525 | Precision Balance MS303TS/00 |
C18 column | Perkin-Elmer Inc | 2580195 | Brownlee Pecosphere RA C18 Cartridge Column - 33 mm x 4.6 mm I.D., Pkg. 5 |
cap crimper | MilliporeSigma | Z114243 | Hand-operated aluminum cap crimper O.D. 20 mm |
Capillary column | J & W Scientific | 122-1011 | 15 m × 0.25 mm i.d. fused silica capillary column coated with a DB-1 stationary phase of 0.25 mm film thickness |
Centrifuge | Sigma 3-18KS | ||
Chloroform | Sigma-Aldrich | 528730 | Chloroforme, HPLC grade, ≥ 99.9% |
Conical Flasks: 100 mL, | 4980016 | Borosil Erlenmeyer Flasks Graduated Conical NM Borosilicate | |
Crimp caps with PTFE seal | Supelco | 27455-U | Crimp seals with PTFE/silicone septa |
D8-Retinyl acetate | Cambridge Isotope Laboratories Inc. | DLM-2244-PK | Vitamin A acetate 3-4% cis (10, 14, 19, 19, 19, 20, 20, 20-D8, 90%) |
Dispenser for 1-10 mL | Gilson | F110103 | DISPENSMAN Bottle-top Dispenser |
Dry Block Heater | Grant | Grant QBH2 High Performance Digital Dry Block Heater | |
Ethanol | Sigma-Aldrich | 459844 | Ethyl alcohol, Pure, ≥ 99.5%, ACS reagent, 200 proof |
GC-MS | Agilent | Agilent 7890 A Series Gas Chromatography with 5975C Mass Spectrometer System equipped with a 5975C inert XL EI/CI MSD/DS Turbo CI System, a 7693A Auto‐injector Includes transfer turret and a 7693 sample Tray | |
Glass stoppered volumetric Flasks: 2000 mL | 956854 | BRAND BLAUBRAND volumetric flask, glass stopper, clear glass | |
Glass stoppered volumetric Flasks: 100 mL | 956849 | BRAND BLAUBRAND volumetric flask, glass stopper, clear glass | |
Glass stoppered volumetric Flasks: 1000 mL | 956853 | BRAND BLAUBRAND volumetric flask, glass stopper, clear glass | |
Glass stoppered volumetric Flasks: 25 mL | 956841 | BRAND BLAUBRAND volumetric flask, glass stopper, clear glass | |
Glass stoppered volumetric Flasks: 50 mL | 956847 | BRAND BLAUBRAND volumetric flask, glass stopper, clear glass | |
Glass stoppered volumetric Flasks: 500 mL | 956852 | BRAND BLAUBRAND volumetric flask, glass stopper, clear glass | |
Helium (highest purity) | Air Liquide | UN 1046 Helium compressed, Class 2.2 | |
HPLC | Varian | Varian 940LC HPLC with fraction collector | |
Inserts for crimp vials, 5 mm, 175 μL, | AR0-4521-12 | Verex insert, 5 mm Dia, 175 µl, clear, conical bottom, w/bottom spring | |
Measuring Cylinders: 100 mL | 213902402 | DURAN Measuring Cylinder, with Hexagonal Base, Class A | |
Measuring Cylinders: 250 mL | 213903604 | DURAN Measuring Cylinder, with Hexagonal Base, Class A | |
Methane (highest purity) | Air Liquide | UN1971 Methane compressed, Class 2.1 | |
Methanol | Sigma-Aldrich | 34860 | Methanol, suitable for HPLC, ≥ 99.9% |
N, O-bis(trmethylsilyi)trifluoroacetamide (BSTFA) with 10% Trimethylchlorosilane (TMCS) | Thermo Scientific | 043939.22 | |
Nitrogen | Produced by Parker Balston NitroVap Generator | ||
Pasteur Pipettes, glass, | 13-678-20A | Fisherbrand Disposable Borosilicate Glass Pasteur Pipets | |
Quartz glass Cuvettes | EW-83301-12 | Cole-Parmer Standard Single Quartz Cuvettes | |
Retinol | Sigma-Aldrich | 17772 | ≥95.0% (HPLC), ~2700 U/mg |
Retinyl acetate | Sigma-Aldrich | R0635 | analytical standard grade |
Sodium chloride | Sigma-Aldrich | S9888 | Chlorure de sodium, ACS reagent, ≥ 99.0% |
Spectrophotometer | Shimadzu | Uvmini-1240 UV-Vis Spectrophotometer | |
Tetrahydrofuran | Sigma-Aldrich | 439215 | Tetrahydrofurane, HPLC grade, ≥ 99.9%, inhibitor-free |
Ultrasonic cleaner | Bransonic | CPX-952-339R | Branson CPX Bransonic Ultrasonic Bath |
Volumetric Pipettes: 100-1000 µL | 3123000063 | Eppendorf 1-canal micropipette with T.I.P.S. Box 2.1 | |
Volumetric Pipettes: 20-200 µL | 3123000055 | Eppendorf 1-canal micropipette with T.I.P.S. Box 2.0 | |
Vortex mixer | Ika | Vortx Genius 3 |
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