Selective, Accurate, and Precise Quantitation of Glutarylcarnitine in Human Urine from a Patient with Glutaric Acidemia Type I Paul E. Minkler, 1 Maria S.K. Stoll, 1 Stephen T. Ingalls, 1 and Charles L. Hoppel 1,2 * Background: Although correctly used in expanded newborn screening programs to identify patients with possible diseases, flow-injection tandem mass spectrometry (MS/MS) acylcarnitine “profiles” are inadequate for standard clinical uses owing to their limited quantitative accuracy and lack of selectivity. We report the application of our selective, accurate, and precise method for quantification of acylcar- nitines, applied to urine glutarylcarnitine from a patient with glutaric acidemia type I (GAI). Methods: A previously validated acylcarnitine ultra-HPLC-MS/MS method was used, with a focus on analysis of glutarylcarnitine. Calibrants and samples were isolated by solid-phase extraction and de- rivatized with pentafluorophenacyl trifluoromethanesulfonate. Acylcarnitine pentafluorophenacyl esters were eluted in 14-min chromatograms. Standardized calibrants and a 13-point, 200-fold con- centration range calibration curve were used for accurate quantification of glutarylcarnitine. Quality control samples validated method accuracy and long-term analytic stability. Results: Quantification of glutarylcarnitine in urine from a patient with GAI is reported. Long-term analytical stability of the method over a 5-year period is shown. Conclusions: Our method for acylcarnitine quantification is shown to be selective, accurate, and precise; thus, we recommend it for confirmatory testing and monitoring of plasma and urine samples from patients with GAI. IMPACT STATEMENT This article describes the application of our validated ultra-HPLC (UHPLC)–tandem mass spec- trometry (MS/MS) acylcarnitine method to the selective, quantitative analysis of glutarylcarnitine in human urine, as well as plasma and cerebrospinal fluid. Specifically, glutaric acidemia type I pa- tients who are low excretors of the diagnostic markers glutaric acid and 3-hydroxy-glutaric acid have benefited from this technique. Our selective multidimensional UHPLC chromatographic sys- tem separates C5 dicarboxylic acylcarnitines (e.g., glutarylcarnitine, ethylmalonylcarnitine, and methylsuccinylcarnitine). Standardized calibrants and multiple-point calibration curves provide highly accurate quantification. These results are not available from flow-injection MS/MS “profiles.” 1 Center for Mitochondrial Diseases, Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH; 2 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH. *Address correspondence to this author at: Department of Pharmacology, Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4965. Fax 216-368-1300; e-mail charles.hoppel@case.edu. ARTICLES November 2017 | 02:03 | 335–344 | JALM 335 ............................................................................................................. Downloaded from https://academic.oup.com/jalm/article/2/3/335/5587561 by guest on 19 November 2022