Evaluation of a New HPLC, a New Tandem MS and a New Data Processing Software for General Clinical Use

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Evaluation of a New HPLC, a New Tandem MS and a New Data Processing Software for General Clinical Use Shih-Tse Jason Lai, Jia Wang, Brad Hart, Kristine Van Natta, Marta Kozak, Jorge Valdivia, Haibo Wang, and Erkan Diri Thermo Fisher Scientific, San Jose, CA

Overview Purpose: This study evaluated a new two-channel HPLC, a new Tandem MS and a data processing software for general clinical use, focusing on the areas of stability, robustness and time efficiency. Methods: The testing methods included analyzing specimens of synthetic serum and urine spiked with standards and stable isotopic internal standards. The HPLC was operated with or without using on-line sample cleanup. The Tandem MS was operated using a selected reaction monitoring (SRM) method with polarity switching mode and with HESI ionization, or APCI ionization. The instruments in use were prototype (production equivalent) units of Thermo Scientific Prelude MD HPLC and Thermo Scientific Endura MD mass spectrometer. The data analysis was performed on Thermo Scientific ClinQuan MD prototype (production equivalent) software. Results: A total of 500 crashed synthetic serum samples spiked with Alprazolam and isotopically-labeled internal standard were analyzed continuously for 24 hours, with an additional 11 QC samples inserted at intervals during the same 24 hours. Crosschannel %RSD s (n=500) of retention time and concentration was observed at 0.85, 1.39, respectively. The precision studies of different ionization modes with HESI and APCI were conducted using four example compounds with polarity switching mode (+/- ) in synthetic urine and synthetic serum (n=40, 5 replicates, 4 runs, 2 channels). HESI: Reserpine(+); Chloramphenicol (-). APCI: Testosterone (+); Estradiol (-). The corresponding %RSD s of concentrations are 1.74, 4.48, 1.84 and 7.20, respectively. This study demonstrated the performance of robustness and precision of these three Class I medical devices for general clinical use. Introduction There is an increasing interest in using LC-tandem MS in clinical laboratories because users can develop their own tests, use a smaller amount of samples, and measure several analytes in a single run. Starting from the 1950's, breath samples had been analyzed by MS, followed by body fluids and other complex biological matrices. Various innovative mass spectrometry technologies have been developed for the detection of a wide range of compounds, including parent compounds and metabolites. Mass spectrometers coupled in series (tandem MS) provide definitive identification and quantitation of target compounds using specific transitions from precursor ions to product ions. Different sample cleanup techniques and chromatographic separations are used prior to delivering compounds into the mass spectrometer. In addition to choosing appropriate technologies for analysis of target compounds, clinical laboratories often encounter challenges with sample clean-up (pre-analytical phase) and data processing (post-analytical phase) when facing the demand to provide test results in a timely manner with increasing numbers of incoming samples. In this study, we evaluated three Class I medical devices to address these challenges: Prelude MD (two channel HPLC), Endura MD (tandem MS) and ClinQuan MD (data processing software). The HPLC instrument consists of two separate channels, both of which include an online sample cleanup Thermo Scientific TurboFlow column for removing sample matrix, and an analytical column for chromatographic separation. This HPLC is capable of cross-channel sequencing by only introducing the portion of the chromatogram of target compounds into the mass spectrometer therefore doubling the sample throughput. The mass spectrometer is a triple-stage quadrupole tandem MS, providing up to 500 SRM transitions per second for compound identification and quantitation. The data processing software includes three levels of user permissions for technicians, supervisors, and lab directors. This software has built-in flexibility in assigning roles and responsibilities, and an audit trail function is provided for streamlining record keeping. Methods Sample Preparation Calibration Standards, Internal Standard (IS), QC sample and test sample were spiked with standards in crashed synthetic serum and synthetic urine as shown in Tables 1 to 3 below. 2 Evaluation of a New HPLC, a New Tandem MS and a New Data Processing Software for General Clinical Use

TABLE 1. Concentrations of Robustness Study Various Samples Concentrations (ng/ml) Calibration Standard (Alprazolam) 1, 2, 5, 10, 25, 50 and 100 Internal Standard (Alprazolam-D5) 5 QC (Alprazolam) Mean (n=11) 5.82 Test Sample (Alprazolam) Mean (n=500) 10.48 TABLE 2. Concentrations of Precision Study HESI Probe Polarity Switching Various Samples Concentrations (ng/ml) HESI Positive Calibration Standard (Reserpine) 0.2, 0.5, 1, 2, 5 and 10 Internal Standard (Reserpine-D9) 2 Test Sample (Reserpine) Mean (n=40) 1.05 HESI Negative Calibration Standard (Chloramphenicol) 2, 5, 10, 20, 50 and 100 Internal Standard (Chloramphenicol-D5) 20 Test Sample (Chloramphenicol) Mean (n=40) 10.31 TABLE 3. Concentrations of Precision Study APCI Probe Polarity Switching Various Samples Concentrations (ng/ml) APCI Positive Calibration Standard (Testosterone) 2, 5, 10, 20, 50 and 100 Internal Standard (Testosterone-D3) 20 Test Sample (Testosterone) Mean (n=40) 30.53 APCI Negative Calibration Standard (Estradiol) 4, 10, 20, 40, 100 and 200 Internal Standard (Estradiol-D5) 40 Test Sample (Estradiol) Mean (n=40) 61.11 Liquid Chromatography The Prelude MD HPLC consists of two separation channels, both of which include an on-line sample cleanup TurboFlow column for removing sample matrix, and an analytical column for compound separation. The instrument is capable of crosschannel sequencing for efficient use of the mass spectrometer time. The HPLC parameters for each channel (Channel 1 and Channel 2) were set as in Tables 4 to 6 below. TABLE 4. HPLC Parameters for Robustness Study HPLC Parameters TurboFlow Column Thermo Scientific Cyclone-P (50x0.5mm) ; 25ºC Analytical Column Thermo Scientific Accucore aq column (50x2.1mm, 2.6um) ; 30ºC Loading Mobile Phase A 10 mm ammonium formate, 0.05% formic acid in water Loading Mobile Phase B 10 mm ammonium formate, 0.05% formic acid in methanol Loading Mobile Phase C Isopropanol:acetonitrile:acetone (45:45:10) Eluting Mobile Phase A 0.05% formic acid in water Eluting Mobile Phase B 0.05% formic acid in methanol Injection Volume 10 ul TABLE 5. HPLC Parameters for Precision Study HESI Probe HPLC Parameters Analytical Column Hypersil Gold (50 x 2.1mm, 3 µm); 30ºC Eluting Mobile Phase A 0.05% formic acid in water Eluting Mobile Phase B Methanol Injection Volume 10 ul Thermo Scientifi c Poster Note ENDO PN64361-EN 0215S 3

TABLE 6. HPLC Parameters for Precision Study APCI Probe HPLC Parameters TurboFlow Column Thermo Scientific Cyclone-P (50x0.5mm) ; 25ºC Analytical Column Thermo Scientific Accucore aq column (50x2.1mm, 2.6um) ; 30ºC Loading Mobile Phase A Water Loading Mobile Phase B Methanol Loading Mobile Phase C Isopropanol:acetonitrile:acetone (45:45:10) Eluting Mobile Phase A Water Eluting Mobile Phase B Methanol Injection Volume 20 ul FIGURE 1. Cross channel sequencing for two parallel HPLC separations with series MS detection increase MS utilization Mass Spectrometry The Endura MD MS is a tandem MS equipped with the neutral blocker that keeps ion optics cleaner, and the advanced electronics that maintains mass stability. Tandem MS was operated in selected reaction monitor (SRM) mode with heated electrospray ionization (HESI) probe or APCI probe in polarity switching mode using the following transition parameters in Table 7. TABLE 7. Tandem MS Parameters Compound Precursor (m/z) Product (m/z) Type Probe /Polarity Alprazolam 309.22 274.11 Confirming Ion HESI/Pos 309.22 281.06 Quantifying Ion HESI/Pos Alprazolam D-5 314.25 279.09 Confirming Ion HESI/Pos 314.25 286.08 Quantifying Ion HESI/Pos Reserpine 609.30 195.00 Quantifying Ion HESI/Pos Reserpine D-9 618.30 204.00 Quantifying Ion HESI/Pos Chloramphenicol 321.00 152.00 Quantifying Ion HESI/Neg 321.00 257.00 Confirming Ion HESI/Neg Chloramphenicol-D5 325.95 157.00 Quantifying Ion HESI/Neg 325.95 262.00 Confirming Ion HESI/Neg Testosterone 289.30 97.23 Confirming Ion APCI/Pos 289.30 109.20 Quantifying Ion APCI/Pos Testosterone-D3 292.30 97.24 Confirming Ion APCI/Pos 292.30 109.22 Quantifying Ion APCI/Pos Estradiol 271.08 145.14 Confirming Ion APCI/Neg 271.08 183.13 Quantifying Ion APCI/Neg Estradiol-D5 275.98 145.09 Confirming Ion APCI/Neg 275.98 187.15 Quantifying Ion APCI/Neg Data Analysis The test results of LC-MS analysis were processed using ClinQuan MD prototype software. 4 Evaluation of a New HPLC, a New Tandem MS and a New Data Processing Software for General Clinical Use

Results Robustness Study HPLC Solvent Consumption This HPLC instrument uses a low amount of solvents for each injection, and Table 8 below shows the solvent consumption for each injection in this study. TABLE 8. Low Solvent Consumption Solvent Loading Mobile Phase A Loading Mobile Phase B Loading Mobile Phase C Eluting Mobile Phase A Eluting Mobile Phase B Usage per Injection 2.83 ml 1.40 ml 1.00 ml 1.87 ml 0.53 ml Improving Productivity; Maximizing MS Utilization and Throughput This HPLC instrument includes automation of online sample cleanup using TurboFlow Technology, and therefore removing tedious hands-on manual steps. The use of two HPLC channel separations minimizes MS idle time. With a single channel HPLC instrument, the MS has idle time not acquiring data, whilst waiting for chromatographic elution. Figure 1 depicts the schematic process of cross channel sequencing of two parallel HPLC separations. This multichannel optimization technology removes idle time, increase utilization time of tandem MS, and doubles the sample throughput. A total of 500 crashed synthetic samples spiked with Alprazolam standard and isotopic internal standard were analyzed continuously for 24 hours, with an additional 11 QC samples. Retention time measurements showed a precision of 0.85% RSD as shown in Figure 2. All QC values were within 2 standard deviations. Tandem MS Performance: Stability, Precision and Robustness This Tandem MS provides excellent stability for quantitative measurements. For 500 injections measuring concentrations, 1.39% RSD was achieved as shown in Figure 3. All QC values were within 2 standard deviations. FIGURE 2. Retention Time Plot of 500 injections from two HPLC channels ; Average Retention Time = 0.74 min, %RSD = 0.85% FIGURE 3. Concentration Plot of 500 injections; Average Concentration = 10.48 ng/ml, %RSD = 1.39% Stability of Mass Ion Ratios The ion ratio of confirming ion to quantifying ion demonstrated an excellent stability over 500 injections as shown in the Table 9 below. TABLE 9. Stability of Mass Ion Ratios Compound Ion Ratio Average %RSD Alprazolam m/z 274.11 to m/z 281.06 0.1918 1.31 Alprazolam-D5 IS m/z 279.09 to m/z 286.08 0.2166 2.43 Precision Study The precision studies of different ionization modes on HESI probe and APCI probe were conducted using four example compounds with polarity switching (+/-) in synthetic urine and synthetic serum (n=40, 5 replicates, 4 runs, 2 channels). HESI: Reserpine(+); Chloramphenicol (-). APCI: Testosterone (+); Estradiol (-). The corresponding %RSD s of concentrations are 1.74, 4.48, 1.84 and 7.20, respectively., as shown in Table 10. Thermo Scientifi c Poster Note ENDO PN64361-EN 0215S 5

TABLE 10. Precision Study Compound Ionization Polarity Replicates (N) Mean (ng/ml) %RSD Reserpine HESI Positive 40 1.05 1.74 Chloramphenicol HESI Negative 40 10.31 4.48 Testosterone APCI Positive 40 30.53 1.84 Estradiol APCI Negative 40 61.11 7.20 Data Analysis The data processing software includes three levels of user permissions for technicians, supervisors, and lab directors as shown in Figure 4 below. This software has built-in flexibility in assigning roles and responsibilities, and audit trail function is provided for streamlining record keeping. FIGURE 4. ClinQuan MD software streamlines workflows, addresses CLIArequired roles and responsibilities, maintains records, helps ensure data integrity Conclusion This study demonstrated the performance of robustness and precision of these three Class I medical devices for general clinical use. The analytical performance of Prelude MD HPLC and Endura MD MS was demonstrated in this study of 500 injections, showing stability, robustness, and timeefficiency for the LC-Tandem MS analysis with a continuous run time of 24 hours. ClinQuan MD data processing software streamlines workflow and helps ensure data integrity. FIGURE 5. Prelude MD HPLC (Left) and Endura MD MS (Right) For in vitro diagnostic use. Thermo Finnigan LLC, a part of Thermo Fisher Scientifi c Inc. 355 River Oaks Parkway, San Jose, CA 95134, United States Tel. (408) 965-6000 Printed in the United States. www.thermoscientific.com/enduramd 2015 Thermo Fisher Scientifi c Inc. All rights reserved. ISO is a trademark of the International Standards Organization. All other trademarks are the property of Thermo Fisher Scientifi c and its subsidiaries. This information is presented as an example of the capabilities of Thermo Fisher Scientifi c products. It is not intended to encourage use of these products in any manners that might infringe the intellectual property rights of others. Specifi cations, terms and pricing are subject to change. Not all products are available in all countries. Please consult your local sales representative for details. Thermo Fisher Scientifi c, San Jose, CA USA is ISO 13485 Certifi ed. ISO 13485 Africa +43 1 333 50 34 0 Australia +61 3 9757 4300 Austria +43 810 282 206 Belgium +32 53 73 42 41 Canada +1 800 530 8447 China 800 810 5118 (free call domestic) 400 650 5118 PN64361-EN 0315S Denmark +45 70 23 62 60 Europe-Other +43 1 333 50 34 0 Finland +358 9 3291 0200 France +33 1 60 92 48 00 Germany +49 6103 408 1014 India +91 22 6742 9494 Italy +39 02 950 591 Japan +81 45 453 9100 Korea +82 2 3420 8600 Latin America +1 561 688 8700 Middle East +43 1 333 50 34 0 Netherlands +31 76 579 55 55 New Zealand +64 9 980 6700 Norway +46 8 556 468 00 Russia/CIS +43 1 333 50 34 0 Singapore +65 6289 1190 Spain +34 914 845 965 Sweden +46 8 556 468 00 Switzerland +41 61 716 77 00 UK +44 1442 233555 USA +1 800 532 4752