Développement et validation d’une méthode de séparation et quantification des acides biliaires sériques par LC-MS/MS, profilage et comparaison avec la méthode enzymatique traditionnelle

Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease during pregnancy. It is characterized by pruritus and is associated with an increased concentration of bile acids in blood, which may lead to an increased risk of perinatal consequences, including spontaneous preterm delivery and an increased risk of death at birth, among others. The medical treatment of this disease currently relies on ursodeoxycholic acid (UDCA) which reduces pruritus and maternal biochemical abnormalities in some cases. Currently, the diagnosis of ICP is made using an enzymatic assay to measure total serum bile acids. We hypothesize that profiling of the individual bile acids would make it possible to assess the risk of complications in women with ICP. By analyzing the bile acid profiles, it could be possible to determine which specie(s) is responsible for these complications and thus to distinguish subgroups of patients at higher risk of complications or who would respond better to treatment. In addition, we believe that UDCA treatment, being a bile acid itself, could interfere with the quantification of total serum bile acids, particularly in the most problematic cases of CIG where high doses of this compound are administered. If this was the case, it would mean that the reference values would need to be changed depending on the administered treatment. The research project aims to develop and validate a method for quantifying bile acids in serum by liquid chromatography coupled to a tandem mass spectrometer (LC-MS/MS), which would allow profiling of serum bile acids in affected women and which would also make it possible later to evaluate the effects of UDCA treatment on this profiling. A method for the quantification of bile acids by liquid chromatography coupled to tandem mass spectrometry has been developed and validated. The supernatants obtained by precipitation of proteins with methanol were injected onto the LC-MS/MS. The separation was carried out using reversed-phase chromatography on a C18 hydrophobic interactions type column. Ionic transitions on the mass spectrometer were determined for all bile acids species beforehand and deuterated cholic acid, deuterated chenodeoxycholic acid and deuterated deoxycholic acid were used as internal standards. Fifteen bile acids, including conjugated and free bile acids, were separated and quantified by LC–MS/MS using electrospray ionization (ESI) in negative ion mode. Quantification was performed in multiple reaction monitoring (MRM) mode with external calibration curve methods. Correlation coefficients for standard curves for all bile acids were greater than 0.9966. The method developed showed acceptable precision, with intra-assay imprecision of less than 3.2% for all the bile acid species studied (for samples at 0.8 and 5 μg/mL) and inter-assay imprecision under 15%. An average ion suppression of 8.2% was observed, which was judged acceptable. Finally, a good correlation was obtained between the LC-MS/MS method and an enzymatic method (r = 0.964). In conclusion, a functional, efficient and rapid method was developed to quantify the individual serum bile acids and different bile acids profiles representing a wide range of concentrations were compared. The comparison of the bile acid profiles suggests that the main bile acids responsible for the increase in total bile acids concentration in blood for samples at a concentration of more than 10 μmol/L are glycocholic acid (GCA), taurocholic acid (TCA), glycoursodeoxycholic acid (GUDCA). This new validated method, and the preliminary data on bile acid profiles in clinical samples, will allow us to initiate prospective clinical analyses to assess the effect of UDCA treatment on total bile acid concentrations and profiles in patients with intrahepatic cholestasis of pregnancy.

Keyphrases: LC-MS/MS, Liver, Intrahepatic cholestasis of pregnancy, Bile acids