Enhancement of in vitro and in vivo microdialysis recovery of SB-265123 using Intralipid and Encapsin as perfusates

Improving Clearance for Renal Replacement Therapy

The adequacy of hemodialysis is now assessed by measuring the removal of a single solute, urea. The urea clearance provided by current dialysis methods is a large fraction of the blood flow through the dialyzer, and, therefore, cannot be increased much further. However, other solutes, which are less effectively cleared than urea, may contribute more to the residual uremic illness suffered by patients on hemodialysis. Here, we review a variety of methods that could be used to increase the clearance of such nonurea solutes. New clinical studies will be required to test the extent to which increasing solute clearances improves patients' health.

Immunosuppressant quantification in intravenous microdialysate - towards novel quasi-continuous therapeutic drug monitoring in transplanted patients

OBJECTIVES

Therapeutic drug monitoring (TDM) plays a crucial role in personalized medicine. It helps clinicians to tailor drug dosage for optimized therapy through understanding the underlying complex pharmacokinetics and pharmacodynamics. Conventional, non-continuous TDM fails to provide real-time information, which is particularly important for the initial phase of immunosuppressant therapy, e.g., with cyclosporine (CsA) and mycophenolic acid (MPA).

METHODS

We analyzed the time course over 8 h of total and free of immunosuppressive drug (CsA and MPA) concentrations measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 16 kidney transplant patients. Besides repeated blood sampling, intravenous microdialysis was used for continuous sampling. Free drug concentrations were determined from ultracentrifuged EDTA-plasma (UC) and compared with the drug concentrations in the respective microdialysate (µD). µDs were additionally analyzed for free CsA using a novel immunosensor chip integrated into a fluorescence detection platform. The potential of microdialysis coupled with an optical immunosensor for the TDM of immunosuppressants was assessed.

RESULTS

Using LC-MS/MS, the free concentrations of CsA (fCsA) and MPA (fMPA) were detectable and the time courses of total and free CsA comparable. fCsA and fMPA and area-under-the-curves (AUCs) in µDs correlated well with those determined in UCs (r≥0.79 and r≥0.88, respectively). Moreover, fCsA in µDs measured with the immunosensor correlated clearly with those determined by LC-MS/MS (r=0.82).

CONCLUSIONS

The new microdialysis-supported immunosensor allows real-time analysis of immunosuppressants and tailor-made dosing according to the AUC concept. It readily lends itself to future applications as minimally invasive and continuous near-patient TDM.

Nose-to-Brain Delivery of Diazepam from an Intranasal Aqua-Triggered In-Situ (ATIS) Gelling Microemulsion: Monitoring Brain Uptake by Microdialysis

BACKGROUND AND OBJECTIVES

An innovative intranasal aqua-triggered in-situ (ATIS) gel is a polymer-free in-situ gelling microemulsion which gels instantaneously on contact with minute quantities of water to form a mucoadhesive gel. The objective of the study was to develop ATIS diazepam (ATIS-diazepam) as an alternative to the injection for epileptic emergencies and evaluate its brain uptake and nose-to-brain targeting efficiency in rats.

METHODS

ATIS-diazepam (1 mg/100 µL) was prepared and characterized for in vitro formulation characteristics. An LC-MS/MS method was developed and validated for the bioanalysis of diazepam. In vivo studies for pharmacokinetics, brain uptake and nasal irritation of intranasal ATIS-diazepam were conducted in rats. Brain uptake was investigated with brain microdialysis, a highly sensitive technique enabling quantification of free drug, which correlates to efficacy.

RESULTS

ATIS-diazepam exhibited globule size < 200 nm, low viscosity, negative zeta potential and good stability. A significant increase in mucoadhesion was exhibited by ATIS-diazepam following the addition of a small quantity of water. ATIS-diazepam showed burst release in pH 6.4 with 50% diazepam release in ~ 10 min, which was sustained over 1 h. The absolute bioavailability was ~ 50% with both intranasal free-diazepam and ATIS-diazepam. Intranasal administration of ATIS-diazepam revealed immediate absorption with rapid and high brain extracellular fluid concentration compared to intravenous free-diazepam solution. The estimated direct transport potential and drug targeting efficiency of intranasal ATIS-diazepam was significantly higher (2-fold) than intranasal free-diazepam solution, which was attributed to the mucoadhesive and microemulsion properties of ATIS-diazepam. The nasal irritation study revealed the safety of ATIS-diazepam compared to free-diazepam solution.

CONCLUSION

Intranasal ATIS-diazepam showed promise of higher direct nose-to-brain targeting, better safety and hence has an immense implication in the treatment of epileptic emergencies.

Skin microdialysis: methods, applications and future opportunities-an EAACI position paper

Skin microdialysis (SMD) is a versatile sampling technique that can be used to recover soluble endogenous and exogenous molecules from the extracellular compartment of human skin. Due to its minimally invasive character, SMD can be applied in both clinical and preclinical settings. Despite being available since the 1990s, the technique has still not reached its full potential use as a tool to explore pathophysiological mechanisms of allergic and inflammatory reactions in the skin. Therefore, an EAACI Task Force on SMD was formed to disseminate knowledge about the technique and its many applications. This position paper from the task force provides an overview of the current use of SMD in the investigation of the pathogenesis of chronic inflammatory skin diseases, such as atopic dermatitis, chronic urticaria, psoriasis, and in studies of cutaneous events during type 1 hypersensitivity reactions. Furthermore, this paper covers drug hypersensitivity, UVB-induced- and neurogenic inflammation, and drug penetration investigated by SMD. The aim of this paper is to encourage the use of SMD and to make the technique easily accessible by providing an overview of methodology and applications, supported by standardized operating procedures for SMD in vivo and ex vivo.

Combined Microdialysis-Tumor Homogenate Method for the Study of the Steady State Compartmental Distribution of a Hydrophobic Anticancer Drug in Patient-Derived Xenografts

PURPOSE

To develop a reproducible microdialysis-tumor homogenate method for the study of the intratumor distribution of a highly hydrophobic anticancer drug (SN-38; 7-ethyl-10-hydroxycamptothecin) in neuroblastoma patient-derived xenografts.

METHODS

We studied the nonspecific binding of SN-38 to the microdialysis tubing in the presence of 2-hydroxypropyl-beta-cyclodextrin (HPBCD) in the perfusate. We calibrated the microdialysis probes by the zero flow rate (ZFR) method and calculated the enhancement factor (f = extrapolated SN-38 concentration at the ZFR / SN-38 concentration in the dialysed solution) of HPBCD. We characterized the extravasation of HPBCD to tumors engrafted in mice. In vivo microdialysis and terminal homogenate data at the steady state (subcutaneous pump infusions) were used to calculate the volume of distribution of unbound SN-38 (Vu,tumor) in neuroblastoma.

RESULTS

HPBCD (10% w/v) in the perfusate prevented the nonspecific binding of SN-38 to the microdialysis probe and enhanced SN-38 recovery (f = 1.86). The extravasation of HPBCD in the tumor during microdialysis was lower than 1%. Vu,tumor values were above 3 mL/g tumor for both neuroblastoma models and suggested efficient cellular penetration of SN-38.

CONCLUSIONS

The method contributes to overcome the limitations of the microdialysis technique in hydrophobic drugs and provides a powerful tool to characterize compartmental anticancer drug distribution in xenografts.

Mass spectrometric detection of neuropeptides using affinity-enhanced microdialysis with antibody-coated magnetic nanoparticles

Microdialysis (MD) is a useful sampling tool for many applications due to its ability to permit sampling from an animal concurrent with normal activity. MD is of particular importance in the field of neuroscience, in which it is used to sample neurotransmitters (NTs) while the animal is behaving in order to correlate dynamic changes in NTs with behavior. One important class of signaling molecules, the neuropeptides (NPs), however, presented significant challenges when studied with MD, due to the low relative recovery (RR) of NPs by this technique. Affinity-enhanced microdialysis (AE-MD) has previously been used to improve recovery of NPs and similar molecules. For AE-MD, an affinity agent (AA), such as an antibody-coated particle or free antibody, is added to the liquid perfusing the MD probe. This AA provides an additional mass transport driving force for analyte to pass through the dialysis membrane and thus increases the RR. In this work, a variety of AAs have been investigated for AE-MD of NPs in vitro and in vivo, including particles with C18 surface functionality and antibody-coated particles. Antibody-coated magnetic nanoparticles (AbMnP) provided the best RR enhancement in vitro, with statistically significant (p < 0.05) enhancements for 4 out of 6 NP standards tested, and RR increases up to 41-fold. These particles were then used for in vivo MD in the Jonah crab, Cancer borealis, during a feeding study, with mass spectrometric (MS) detection. 31 NPs were detected in a 30 min collection sample, compared to 17 when no AA was used. The use of AbMnP also increased the temporal resolution from 4 to 18 h in previous studies to just 30 min in this study. The levels of NPs detected were also sufficient for reliable quantitation with the MS system in use, permitting quantitative analysis of the concentration changes for 7 identified NPs on a 30 min time course during feeding.

Optimization of perfusate pH to improve microdialysis recovery of lipophilic compounds

INTRODUCTION

Microdialysis (MD) allows sampling of compounds in-vivo from tissues' interstitial fluid. However, molecules insoluble at physiological pH have usually extremely low recovery. The addition of albumin to the perfusate or the use of isotonic lipoemulsion improves recovery of these molecules although it requires a cleaning step before HPLC analysis. This study investigates the possibility of improving the MD recovery of compounds insoluble at physiological pH but soluble at a different pH. The probe is perfused with an isotonic solution adjusted to pH values at which the compound has maximum solubility. Ketoconazole (KTC), clotrimazole (CLT) and tretinoin (TTN) were selected as model drugs because they are almost insoluble at pH 7.4 but soluble at pH 4 for KTC and CTL; and at pH 9 for TTN.

METHODS

Linear microdialysis probes were used to collect KTC, CLT or TTN from a standard solution of the compounds. Probes were perfused with 0.01 M pH 7.4 isotonic buffer solution (1) without or (2) with 5% Bovine Serum Albumin (BSA); or (3) with 20% isotonic lipoemulsion; or (4) with 0.01 M pH 4 isotonic buffer solution for KTC and CLT or 0.01 M pH 9 isotonic buffer solution for TTN. The method was then tested in-vivo, in rabbit skin, to assess the skin tolerance to the non-physiological perfusates and to monitor KTC and TTN delivery from commercial cream products.

RESULTS

In-vitro, the optimized-pH perfusate increased MD recovery significantly (P<0.001): 6.9 (KTC), 8.3 (CLT), and 2.0 (TTN) times compared to the physiological pH and 1.4 and 1.2 compared to the BSA and lipoemulsion respectively. No evidence of irritation or edema was observed in-vivo. However, KTC and TTN were not detected in-vivo with any of the modified perfusate tested.

DISCUSSION

These findings show that the optimized-pH perfusate effectively increases the in-vitro microdialysis recovery of KTC, CLT and TTN and that it is well tolerated in-vivo. However, the compounds tested (KTC and TTN) could not be detected in-vivo.

CEREBRAL UPTAKE OF DRUGS IN HUMANS

1. Drugs that target the central nervous system (CNS) are under-represented in the pharmacopoeia because of the difficulties of overcoming passive and active defences of the blood-brain barrier (BBB). Methods have been developed in drug discovery to make decisions about whether a compound crosses the BBB. Less is known about how the rate and extent of CNS penetration of a drug affects its clinical behaviour, largely because of past difficulties in measuring the cerebral uptake of drugs in humans. Three methods for doing so are reviewed. 2. Microdialysis is sometimes used as a clinical tool for monitoring the brain in neurointensive care and opportunistic pharmacological studies are possible. The method is relatively cheap and simple, measures free drug concentrations and is better suited to characterizing slowly changing brain drug concentrations. 3. Measuring cerebral drug uptake using positron emission tomography imaging requires the use of short-lived isotopes (labelled drug or labelled receptor ligand). Data with high spatial and temporal resolution can be collected, but the method requires expensive infrastructure. 4. Jugular bulb catheters collect pure brain venous blood and are sometimes placed for neuromonitoring. Cerebral drug uptake is inferred from the arterial to cerebral venous concentration difference. The method is relatively cheap and simple and allows global brain concentrations to be estimated. It is better suited to characterizing rapidly changing brain concentrations and effects. 5. The cerebral kinetics of a cerebro-active drug can make substantial contributions to its clinical behaviour. For example, loperamide is a peripherally acting opioid that has little CNS effect due to the active efflux transport of loperamide from the brain back into the blood by transporters including P-glycoprotein. The opioids alfentanil and fentanyl differ in their duration of action largely because of differences in their cerebral distribution volume rather than differences in systemic kinetics. The onset of anaesthesia of the intravenous anaesthetic propofol is governed almost completely by the kinetics of the first-pass passage of the drug through the brain and is more affected by changes in cerebral blood flow than hepatic clearance. 6. Continuing to exploit and develop these methods may provide new avenues to enhance the safety and efficacy of cerebro-active drugs in clinical practice.

The effect of beta-cyclodextrin on liquid chromatography/electrospray-mass spectrometry analysis of hydrophobic drug molecules

Cyclodextrins (CDs) are widely used in the pharmaceutical industry for their capability of improving bioavailability, solubility, or stability of drugs via the formation of soluble inclusion complexes. CDs have also been widely used in various chemical analysis methods. In this work, liquid chromatography/electrospray mass spectrometry (LC/ESI-MS) analysis for four different drugs (imipramine, desipramine, propranolol, and naproxen) that form inclusion complexes with CDs was performed in the presence and absence of beta-CD. These drugs are subject to nonspecific adsorption when brought into contact with plastics, such as HPLC tubing, sample collection and preparation apparatus, etc. Inclusion of the CD in the samples reduces this nonspecific adsorption due to competitive complex formation between the CD and the analyte. ESI-MS ion intensities increased when beta-CD was included in the sample with concentrations up to 1% (w:v), with a diverter valve installed post LC column. The degree of increased ion signal correlated with the beta-cyclodextrin:analyte binding constant. beta-CD appeared to elute within the void volume time and was observed in a full spectrum scan among the different analyte samples with up to 0.01% beta-CD injected directly to the LC/MS system with the diverter valve switched inline with the mass spectrometer. The use of the diverter valve allowed for direct injection of samples containing up to 1% beta-CD to the LC/MS without any deterioration of analyte ion signal.

No delayed temporal response to sample concentration changes during enhanced microdialysis sampling using cyclodextrins and antibody-immobilized microspheres

The temporal response to concentration changes external to a microdialysis probe containing trapping agents in the perfusion fluid was studied. Native beta-cyclodextrin and a water-soluble beta-cyclodextrin polymer were used as trapping agents in the microdialysis perfusion fluid to study the temporal concentration response to carbamazepine, a hydrophobic analyte. The temporal response of microdialysis probes containing antibody-immobilized microspheres against five different cytokines (tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-4, and IL-5) to concentration changes outside of the probe was also determined. In both cases, no delayed temporal response of enhanced microdialysis was observed for either carbamazepine or the cytokines as compared to standard microdialysis sampling procedures.

Microdialysis—theoretical background and recent implementation in applied life-sciences

In the past decade microdialysis has become a method of choice in the study of unbound tissue concentrations of both endogenous and exogenous substances. Microdialysis has been shown to offer information about substances directly at the site of action while being well tolerable and safe. The large variety of its field of application has been demonstrated. However, a few challenges have to be met to make this method generally applicable in routine applications. This review will provide an overview over theoretical aspects that have to be considered during the implementation of microdialysis. Moreover, a comparison between microdialysis and other tissue sampling techniques will demonstrate advantages and limitations of the methods mentioned. Subsequently, it will present a critical synopsis of a variety of scientific/biomedical applications of this method with emphasis on the most recent literature, focussing on target tissues while giving examples of substances examined. It is concluded that microdialysis will be of great value in future investigations of pharmacokinetics, pharmacodynamics and in monitoring of disease status and progression.