Lactulose

Mannitol diagnostic test by HPLC and LC-MSMS platforms: Considerations for field studies of intestinal barrier function and environmental enteropathy

Gwenyth O. Lee, Peter Kosek, Aldo A M Lima, Ravinder Singh, Pablo Penataro Yori, Maribel P. Olortegui, Jesse L. Lamsam, Domingos B. Oliveira, Richard L. Guerrant, Margaret Kosek

Research output: Contribution to journalArticle

Abstract

Objectives: The lactulose: mannitol (L: M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L: M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms.

Methods: The L: M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated.

Results: The Spearman correlation between the 2 LC-MSMS platforms was high (r≥ 0.89) for mannitol, lactulose, and the L: M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was r=0.95 for mannitol, r=0.70 for lactulose, and r=0.43 for the L: M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree.

Conclusions: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.

Original languageEnglish (US)
Pages (from-to)544-550
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume59
Issue number4
DOIs
StatePublished - Oct 8 2014

Fingerprint

Lactulose
Mannitol
Routine Diagnostic Tests
High Pressure Liquid Chromatography
Disaccharides
Tandem Mass Spectrometry
Liquid Chromatography
Oral Administration
Research Personnel

Keywords

  • Environmental enteropathy
  • Intestinal absorption
  • Intestinal permeability
  • Lactulose
  • Mannitol assay
  • Tropical enteropathy

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

Lactulose : Mannitol diagnostic test by HPLC and LC-MSMS platforms: Considerations for field studies of intestinal barrier function and environmental enteropathy. / Lee, Gwenyth O.; Kosek, Peter; Lima, Aldo A M; Singh, Ravinder; Penataro Yori, Pablo; Olortegui, Maribel P.; Lamsam, Jesse L.; Oliveira, Domingos B.; Guerrant, Richard L.; Kosek, Margaret.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 59, No. 4, 08.10.2014, p. 544-550.

Research output: Contribution to journalArticle

Lee, Gwenyth O. ; Kosek, Peter ; Lima, Aldo A M ; Singh, Ravinder ; Penataro Yori, Pablo ; Olortegui, Maribel P. ; Lamsam, Jesse L. ; Oliveira, Domingos B. ; Guerrant, Richard L. ; Kosek, Margaret. / Lactulose : Mannitol diagnostic test by HPLC and LC-MSMS platforms: Considerations for field studies of intestinal barrier function and environmental enteropathy. In: Journal of Pediatric Gastroenterology and Nutrition. 2014 ; Vol. 59, No. 4. pp. 544-550.
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abstract = "Objectives: The lactulose: mannitol (L: M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L: M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms.Methods: The L: M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated.Results: The Spearman correlation between the 2 LC-MSMS platforms was high (r≥ 0.89) for mannitol, lactulose, and the L: M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was r=0.95 for mannitol, r=0.70 for lactulose, and r=0.43 for the L: M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree.Conclusions: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.",
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T2 - Mannitol diagnostic test by HPLC and LC-MSMS platforms: Considerations for field studies of intestinal barrier function and environmental enteropathy

AU - Lee, Gwenyth O.

AU - Kosek, Peter

AU - Lima, Aldo A M

AU - Singh, Ravinder

AU - Penataro Yori, Pablo

AU - Olortegui, Maribel P.

AU - Lamsam, Jesse L.

AU - Oliveira, Domingos B.

AU - Guerrant, Richard L.

AU - Kosek, Margaret

PY - 2014/10/8

Y1 - 2014/10/8

N2 - Objectives: The lactulose: mannitol (L: M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L: M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms.Methods: The L: M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated.Results: The Spearman correlation between the 2 LC-MSMS platforms was high (r≥ 0.89) for mannitol, lactulose, and the L: M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was r=0.95 for mannitol, r=0.70 for lactulose, and r=0.43 for the L: M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree.Conclusions: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.

AB - Objectives: The lactulose: mannitol (L: M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L: M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms.Methods: The L: M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated.Results: The Spearman correlation between the 2 LC-MSMS platforms was high (r≥ 0.89) for mannitol, lactulose, and the L: M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was r=0.95 for mannitol, r=0.70 for lactulose, and r=0.43 for the L: M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree.Conclusions: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.

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KW - Intestinal absorption

KW - Intestinal permeability

KW - Lactulose

KW - Mannitol assay

KW - Tropical enteropathy

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