Creatine plays an essential role in energy storage and transmission. It is synthesized by arginine:glycine amidinotransferase, which forms guanidinoacetate, which in turn undergoes methylation, catalyzed by S-adenosyl-L-methionine:N-guanidinoacetate methyltransferase, forming creatine. Creatine in plasma/serum is a biochemical marker of primary and secondary creatine defects. The reason for the inclusion of creatine into the analytical repertoire of BEVITAL is a marked decrease in plasma level (up to 40 %) in vitamin B6-deficient subjects (2).
Method: LC-MS/MS.
Detection of primary and secondary creatine defects. Assessment of vitamin B6 status?
Patient/subject: Creatine concentration is increased in subjects taking creatine supplements.
Matrix: EDTA plasma and serum.
Volume: Minimum volume is 50 µL, but 200 µL is optimal and allows reanalysis.
Preparation: The blood sample must be centrifuged and the plasma/serum fraction put on ice, and frozen.
Frozen, on dry ice. (for general instruction on transportation, click here)
Reported values: Creatine in plasma/serum decreases with age, as described in a recent article. Median (2.5th -97.5th percentile) is 60 (16-97) µmol/L at the age of 0-12 years, 48 (14-92) at the age of 13-20 years and 31 (13-57) at the age > 20 years.
1. Midttun, O., Kvalheim, G., and Ueland, P.M. (2013). High-throughput, low-volume, multianalyte quantification of plasma metabolites related to one-carbon metabolism using HPLC-MS/MS. Anal Bioanal Chem 405, 2009-017.
2. da Silva, V.R., Rios-Avila, L., Lamers, Y., Ralat, M.A., Midttun, O., Quinlivan, E.P., Garrett, T.J., Coats, B., Shankar, M.N., et al. (2013). Metabolite profile analysis reveals functional effects of 28-day vitamin B-6 restriction on one-carbon metabolism and tryptophan catabolic pathways in healthy men and women. J Nutr 143, 1719-727.
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Amino acids: Alanine, Arginine, Asparagine, Aspartic acid, Glutamic acid, Glutamine, Glycine, Histidine, Isoleucine, Kynurenine, Leucine, Lysine, Methionine, Ornithine, Phenylalanine, Proline, Sarcosine, Serine, Threonine, Total cysteine, Tryptophan, Tyrosine, Valine
Amino acid catabolites: 2-Aminoadipic acid, 2-Hydroxybutyrate, 3-Hydroxysiobutyrate, α-Hydroxyglutaric acid, β-Alanine, β-Aminoisobutyrate, β-Hydroxy B-methylbutyric acid, Phenylacetylglutamine
Acylcarnities: BB, C0, C2, C3, C3-DC, C4, C4-OH, C4-DC, iC5, C5-DC, C5:1, C6, C8, C10, C12, C14, C14-OH, C16, C16-OH, C18, C18-OH, C18:1, C18:2
TCA metabolites: α-Ketoglutarate, Citrate, Fumarate, Isocitrate, Lactate, Malate, Pyruvate
Ketone bodies: Acetoacetate, 3-Hydroxybutyrate
AGEs: Carboxyethyllysine, Carboxymethyllysine
Kynurenines: 3-hydroxykynurenine, 3-hydroxyanthranilic acid, Anthranilic acid, Kynurenine, Kynurenic acid, Nicotinic acid, Nicotinamide, N1-methylnicotinamide, Picolinic acid, Quinaldic acid, Quinolinic acid, Xanthurenic acid
Neopterin
Proteins: C-Reactive protein, Calprotectin, Serum Amyloid A
Ratio-derived: Kynurenine/tryptophan ratio, PAr index (PLP, PL, PA)
SCFAs: Acetate, Butyrate, Formate, Isobutyrate, Isovalerate, Propionate, Valerate, α-Methylbutyrate
Indoles: 3-Indoxyl sulfate, Imidazole propionate, Indole-3-acetamide, Indole-3-acetate, Indole-3-aldehyde, Indole-3-lactate, Indole-3-propionate
Choline metabolites: Choline, Betaine, DMG, TMAO
Amino acid derived: Phenylacetylglutamine
B-vitamins, functional markers, and methyl donors: 4-Pyridoxic acid, Betaine, Choline, Cobalamin, Flavin mononucleotide, Folate, Methylmalonic acid, N1-methylnicotinamide, Nicotinamide, Nicotinic acid, Pyridoxal, Pyridoxal 5-phosphate, Pyridoxine, Riboflavin, Thiamine, Thiamine monophosphate, Total homocysteine
Fat-soluble vitamins: 25-hydroxy vitamin D2, 25-hydroxy vitamin D3, α-Tocopherol (Vit. E), All-trans retinol (Vit. A), Phylloquinone (Vit. K1), y-Tocopherol (Vit. E)
Essential amino acids: Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, Valine
Meat and fish intake: 1-Methylhistidine, 3-Methylhistidine, B-Alanine, Creatine, Creatinine, TMAO
Tobacco use and coffee intake: Cotinine, Trans-3-hydroxycotinine, Trigonelline
Turnaround time
2-6 weeks, depending on number of samples and laboratory capacity.
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