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Item Analysis of Biofluids by Paper Spray Mass Spectrometry: Advances and Challenges(2016-03) Manicke, Nicholas E.; Bills, Brandon J.; Zhang, Chengsen; Department of Chemistry & Chemical Biology, School of ScienceAbstract Paper spray MS is part of a cohort of ambient ionization or direct analysis methods that seek to analyze complex samples without prior sample preparation. Extraction and electrospray ionization occur directly from the paper substrate upon which a dried matrix spot is stored. Paper spray MS is capable of detecting drugs directly from dried blood, plasma and urine spots at the low ng/ml to pg/ml levels without sample preparation. No front end separation is performed, so MS/MS or high-resolution MS is required. Here, we discuss paper spray methodology, give a comprehensive literature review of the use of paper spray MS for bioanalysis, discuss technological advancements and variations on this technique and discuss some of its limitations.Item Feasibility of Desorption Electrospray Ionization Mass Spectrometry for Diagnosis of Oral Tongue Squamous Cell Carcinoma(Wiley, 2017) D'Hue, Cedric; Moore, Michael; Summerlin, Don-John; Jarmusch, Alan; Alfaro, Clint; Mantravadi, Avinash; Bewley, Arnaud; Farwell, D. Gregory; Cooks, R. Graham; Pathology and Laboratory Medicine, School of MedicineRationale Desorption electrospray ionization mass spectrometry (DESI-MS) has demonstrated utility in differentiating tumor from adjacent normal tissue in both urologic and neurosurgical specimens. We sought to evaluate if this technique had similar accuracy in differentiating oral tongue squamous cell carcinoma (SCC) from adjacent normal epithelium due to current issues with late diagnosis of SCC in advanced stages. Methods Fresh frozen samples of SCC and adjacent normal tissue were obtained by surgical resection. Resections were analyzed using DESI-MS sometimes by a blinded technologist. Normative spectra were obtained for separate regions containing SCC or adjacent normal epithelium. Principal Component Analysis and Linear Discriminant Analysis (PCA-LDA) of spectra were used to predict SCC versus normal tongue epithelium. Predictions were compared with pathology to assess accuracy in differentiating oral SCC from adjacent normal tissue. Results Initial PCA score and loading plots showed clear separation of SCC and normal epithelial tissue using DESI-MS. PCA-LDA resulted in accuracy rates of 95% for SCC versus normal and 93% for SCC, adjacent normal and normal. Additional samples were blindly analyzed with PCA-LDA pixel-by-pixel predicted classifications as SCC or normal tongue epithelial tissue and compared against histopathology. The m/z 700–900 prediction model showed a 91% accuracy rate. Conclusions DESI-MS accurately differentiated oral SCC from adjacent normal epithelium. Classification of all typical tissue types and pixel predictions with additional classifications should increase confidence in the validation model.Item Intraoperative assessment of tumor margins during glioma resection by desorption electrospray ionization-mass spectrometry(National Academy of Sciences, 2017-06-27) Pirro, Valentina; Alfaro, Clint M.; Jarmusch, Alan K.; Hattab, Eyas M.; Cohen-Gadol, Aaron A.; Cooks, R. Graham; Pathology and Laboratory Medicine, School of MedicineGliomas infiltrate into surrounding healthy brain tissue. Microsurgical resection aims for maximal tumor resection while minimizing morbidity. Surgical margins are defined based on the surgeon’s experience, visual observation, and neuronavigation. Surgical margin assessment is rarely undertaken intraoperatively due to time constraints and unreliability of such evaluation. Routine, pathologic intraoperative examination provides no molecular information. Molecular measurements using mass spectrometry can be made rapidly on tissue during surgery to identify tissue types, estimate tumor infiltration, and recognize the presence of prognostic mutations by monitoring oncometabolites and phospholipids. This intraoperative study demonstrates the power of mass spectrometry in assessing diagnostic and prognostic information on discrete surgeon-defined points along the resection margins to improve tumor resection, even in regions without MRI contrast enhancement., Intraoperative desorption electrospray ionization-mass spectrometry (DESI-MS) is used to characterize tissue smears by comparison with a library of DESI mass spectra of pathologically determined tissue types. Measurements are performed in the operating room within 3 min. These mass spectra provide direct information on tumor infiltration into white or gray brain matter based on N-acetylaspartate (NAA) and on membrane-derived complex lipids. The mass spectra also indicate the isocitrate dehydrogenase mutation status of the tumor via detection of 2-hydroxyglutarate, currently assessed postoperatively on biopsied tissue using immunohistochemistry. Intraoperative DESI-MS measurements made at surgeon-defined positions enable assessment of relevant disease state of tissue within the tumor mass and examination of the resection cavity walls for residual tumor. Results for 73 biopsies from 10 surgical resection cases show that DESI-MS allows detection of glioma and estimation of high tumor cell percentage (TCP) at surgical margins with 93% sensitivity and 83% specificity. TCP measurements from NAA are corroborated by indirect measurements based on lipid profiles. Notably, high percentages (>50%) of unresected tumor were found in one-half of the margin biopsy smears, even in cases where postoperative MRI suggested gross total tumor resection. Unresected tumor causes recurrence and malignant progression, as observed within a year in one case examined in this study. These results corroborate the utility of DESI-MS in assessing surgical margins for maximal safe tumor resection. Intraoperative DESI-MS analysis of tissue smears, ex vivo, can be inserted into the current surgical workflow with no alterations. The data underscore the complexity of glioma infiltration.Item Ionization Suppression and Recovery in Direct Biofluid Analysis using Paper Spray Mass Spectrometry(Springer, 2016-04) Vega, Caroline; Spence, Corina; Zhang, Chengsen; Bills, Brandon J.; Manicke, Nicholas E.; Department of Chemistry & Chemical Biology, School of SciencePaper spray mass spectrometry is a method for the direct analysis of biofluid samples in which extraction of analytes from dried biofluid spots and electrospray ionization occur from the paper on which the dried sample is stored. We examined matrix effects in the analysis of small molecule drugs from urine, plasma, and whole blood. The general method was to spike stable isotope labeled analogs of each analyte into the spray solvent, while the analyte itself was in the dried biofluid. Intensity of the labeled analog is proportional to ionization efficiency, whereas the ratio of the analyte intensity to the labeled analog in the spray solvent is proportional to recovery. Ion suppression and recovery were found to be compound- and matrix-dependent. Highest levels of ion suppression were obtained for poor ionizers (e.g., analytes lacking basic aliphatic amine groups) in urine and approached –90%. Ion suppression was much lower or even absent for good ionizers (analytes with aliphatic amines) in dried blood spots. Recovery was generally highest in urine and lowest in blood. We also examined the effect of two experimental parameters on ion suppression and recovery: the spray solvent and the sample position (how far away from the paper tip the dried sample was spotted). Finally, the change in ion suppression and analyte elution as a function of time was examined by carrying out a paper spray analysis of dried plasma spots for 5 min by continually replenishing the spray solvent.Item Paper Spray Ionization: Applications and Perspectives(Elsevier, 2019) McBride, Ethan M.; Mach, Phillip M.; Dhummakupt, Elizabeth S.; Dowling, Sarah; Carmany, Daniel O.; Demond, Paul S.; Rizzo, Gabrielle; Manicke, Nicholas E.; Glaros, Trevor; Chemistry and Chemical Biology, School of SciencePaper spray ionization has grown to become one of the most successful ambient ionization methods within the past decade. Requiring little to no sample preparation and being remarkably simple to construct, this technique has seen application in a wide number of fields. This review approaches the mechanism of how paper spray works, and seeks to better classify what it is and is not in a rapidly expanding field of ambient techniques. Additionally, many applications of the technique in clinical, forensic, environmental, and reaction monitoring regimes are explored. Finally, perspectives towards the future of how paper spray could be utilized will be expanded upon, including unexplored substrates and possibilities for the 'omics space.Item Separation of Opiate Isomers using Electrospray Ionization and Paper Spray Coupled to High-Field Asymmetric Waveform Ion Mobility Spectrometry(Springer, 2015-05) Manicke, Nicholas E.; Belford, Michael; Department of Chemistry & Chemical Biology, IU School of ScienceOne limitation in the growing field of ambient or direct analysis methods is reduced selectivity caused by the elimination of chromatographic separations prior to mass spectrometric analysis. We explored the use of high-field asymmetric waveform ion mobility spectrometry (FAIMS), an ambient pressure ion mobility technique, to separate the closely related opiate isomers of morphine, hydromorphone, and norcodeine. These isomers cannot be distinguished by tandem mass spectrometry. Separation prior to MS analysis is, therefore, required to distinguish these compounds, which are important in clinical chemistry and toxicology. FAIMS was coupled to a triple quadrupole mass spectrometer, and ionization was performed using either a pneumatically assisted heated electrospray ionization source (H-ESI) or paper spray, a direct analysis method that has been applied to the direct analysis of dried blood spots and other complex samples. We found that FAIMS was capable of separating the three opiate structural isomers using both H-ESI and paper spray as the ionization source.Item Simultaneous quantitation of five triazole anti-fungal agents by paper spray-mass spectrometry(De Gruyter, 2020-01-13) Skaggs, Christine L.; Ren, Greta J.; Elgierari, El Taher M.; Sturmer, Lillian R.; Shi, Run Z.; Manicke, Nicholas E.; Kirkpatrick, Lindsey M.; Pediatrics, School of MedicineIntroduction: Invasive fungal disease is a life-threatening condition that can be challenging to treat due to pathogen resistance, drug toxicity, and therapeutic failure secondary to suboptimal drug concentrations. Frequent therapeutic drug monitoring (TDM) is required for some anti-fungal agents to overcome these issues. Unfortunately, TDM at the institutional level is difficult, and samples are often sent to a commercial reference laboratory for analysis. To address this gap, the first paper spray-mass spectrometry assay for the simultaneous quantitation of five triazoles was developed. Methods: Calibration curves for fluconazole, posaconazole, itraconazole, hydroxyitraconazole, and voriconazole were created utilizing plasma-based calibrants and four stable isotopic internal standards. No sample preparation was needed. Plasma samples were spotted on a paper substrate in pre-manufactured plastic cartridges, and the dried plasma spots were analyzed directly utilizing paper spray-mass spectrometry (paper spray MS/MS). All experiments were performed on a Thermo Scientific TSQ Vantage triple quadrupole mass spectrometer. Results: The calibration curves for the five anti-fungal agents showed good linearity (R2 = 0.98 – 1.00). The measured assay ranges (LLOQ – ULOQ) for fluconazole, posaconazole, itraconazole, hydroxyitraconazole, and voriconazole were 0.5 – 50 μg/mL, 0.1 – 10 μg/mL, 0.1 – 10 μg/mL, 0.1 – 10 μg/mL, and 0.1 – 10 μg/mL, respectively. The inter- and intra-day accuracy and precision were less than 25% over the respective ranges. Conclusion: We developed the first rapid paper spray MS/MS assay for simultaneous quantitation of five triazole anti-fungal agents in plasma. The method may be a powerful tool for near point-of-care TDM aimed at improving patient care by reducing turnaround time and for use in clinical research.