Stable isotope dilution method GAA determination
For more than 30 years, guanidinoacetic acid (GAA), together with other guanidino compounds, has been proposed as an important marker for renal failure, in kidney transplantation, and for renal metabolism, especially for the metabolic activity of the renal proximal tubules. Since the discovery of the first patient with guanidinoacetic acid methyltransferase deficiency in 1994 by Stöckler et al. (Pediatr. Res. 1994; 36: 409), GAA has become of great interest for all laboratories involved in the diagnosis of metabolic diseases. In the literature there are several methods described for the determination of GAA, ranging from ion-exchange chromatography with post-column derivatisation, enzymatic methods, gas chromatography/mass spectrometry (GC/MS), to liquid chromatography/atmospheric pressure chemical ionisation mass spectrometry (LC/APCI-MS). Here a stable isotope dilution method for quantitative and accurate determination of GAA in urine, plasma, and cerebrospinal fluid is described. GAA is converted to the bis(trifluoromethyl)pyrimidine di(tert-butyldimethylsilyl) derivative by stepwise derivatisation with hexafluoroacetylacetone and N-(tert-butyldimethylsilyl)-N-methyltrifluoroacetamide (MTBSTFA). Analysis can be performed using a standard benchtop GC/MS system. For quantitative GAA determination with 1,2-(13)C-GAA as internal standard, selected ion monitoring is performed using m/z 460/462, with m/z 432/433 and 375/376 as qualifiers.