An HPLC-GC/MS reference method for serum total cholesterol with control for ester hydrolysis

Currently used isotope-dilution mass spectrometry methods for serum total cholesterol are performed without control in each sample for completeness of hydrolysis of cholesterol esters. In order to monitor this step in the analysis, we developed a method based on both high-pressure liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GC/MS). 13C3-cholesterol and cholesteryl [1-14C] oleate were added to serum that was saponified and extracted into hexane. The extract was subjected to HPLC with collection of the fractions corresponding to cholesterol and cholesteryl oleate. The radio-activity of the latter was counted in order to estimate the nonhydrolysed fraction that on average amounted to less than 0.1% for commonly used ester hydrolysis procedures. The cholesterol fraction was subjected to GC/MS for quantitation using the traditional isotope-dilution principle. Evaluation of accuracy by assaying sera from the National Institute of Standards and Technology showed a deviation from the target value of < 1% with a coefficient of variation of < or = 1.0%. In conclusion, the present reference method for serum total cholesterol assures results based on complete hydrolysis of the cholesterol ester fraction.