Simultaneous quantification of budesonide and its two metabolites, 6beta-hydroxybudesonide and 16alpha-hydroxyprednisolone, in human plasma by liquid chromatography negative electrospray ionization tandem mass spectrometry

Electroless Ionization Mass Spectrometry Using a Compact Electrokinetic Ionization Source

We introduce a new ionization technique for compact, portable mass spectrometers. It consists of a syringe with sample liquid capped by a self-ionizing spray nozzle containing a microfabricated nozzle chip. Interaction of the sample liquid with the nozzle wall results in electrical charging without the need for electronics. Elaborate cleaning procedures are redundant when disposable syringes and mass-fabricated spray nozzles are used. This self-named electroless spray ionization (ELI) technique shows comparable performance to conventional ionization techniques. In contrast to commonly used electrospray ionization, ELI exhibits excellent ionization efficiency for low-conductive solutions such as water or acetonitrile. Due to its compact size and the absence of high-voltage electronics, it can also be readily integrated in other ionization sources. Besides reviewing the main properties of ELI, we showcase the technique's potential for two on-site, ambient mass spectroscopy applications: perfume fingerprinting and fast screening of fungicides on citrus fruits.

A sensitive and high-throughput LC-ESI-MS/MS method to detect budesonide in human plasma: application to an evaluation of pharmacokinetics of budesonide intranasal formulations with and without charcoal-block in healthy volunteers

Budesonide is one of the intranasal corticosteroids, referred as first-line therapy for allergic rhinitis. Its determination is a challenging task due to its extremely low plasma levels, which limits the progress in the investigation of pharmacokinetics and quality control of preparations. In this study, a sensitive and high-throughput method to determine budesonide in human plasma using budesonide-d8 as the internal standard was developed and validated. A small volume of plasma sample (0.2 mL) was diluted with 0.2 mL water, followed by a solid-phase extraction using Cleanert PEP-2 products. Extracted samples were analyzed by liquid chromatography coupled to electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS). Chromatographic separation of analytes was performed on an InertSustain AQ-C18 HP column (3 µm, 2.1 × 50 mm) under the reversed-phase condition with gradient elution. With the assay, linear calibration curves were obtained over the concentration range of 10-1200 pg/mL for budesonide, with considerable extraction recoveries (84.7-89.4%), and negligible matrix effects (<4.1). Moreover, the newly developed method was successfully applied to the evaluation of pharmacokinetics of two budesonide intranasal formulations with and without charcoal block in healthy volunteers.

Determination of Budesonide and Sulfasalazine in Water and Wastewater Samples Using DLLME-SFO-HPLC-UV Method

Dispersive liquid–liquid microextraction based on solidification of floating organic droplet (DLLME-SFO) was applied to isolate budesonide (BUD) and sulfasalazine (SULF) from aqueous samples. The effects of different parameters on the efficiency on the extraction such as type of extrahent and dispersive solvent, ionic strength, pH of sample, and centrifugation time were investigated. Moreover, the influence of foreign substances on a studied process was tested. The calibration curves were recorded. The linearity ranges for BUD and SULF were 0.022–8.611 µg mL−1 and 0.020–7.968 µg mL−1 with the limit of detection (LOD) 0.011 µg mL−1 and 0.012 µg mL−1, respectively. The enrichment factors (EF) for two analytes were high: for BUD it was 145.7 and for SULF, 119.5. The elaborated procedure was applied for HPLC-UV determination of these analytes in water and wastewater samples.

Development and validation of an assay for quantifying budesonide in dried blood spots collected from extremely low gestational age neonates

Budesonide is a potential therapeutic option for the prevention of bronchopulmonary dysplasia in mechanically ventilated premature neonates. The dose and concentrations of budesonide that drive effective prophylaxis are unknown, due in part to the difficulty in obtaining serial blood samples from this fragile population. Of primary concern is the limited total blood volume available for collection for the purposes of a pharmacokinetic study. Dried blood spots (DBS), which require the collection of <200 μL whole blood to fill an entire card, are an attractive low-blood volume alternative to traditional venipuncture sampling. We describe a simple and sensitive method for determining budesonide concentrations in DBS using an ultra-high-performance liquid chromatography - tandem mass spectrometry assay. Budesonide was liberated from a single 6 mm punch using a basified methyl tert-butyl ether extraction procedure. The assay was determined to be accurate and precise in the dynamic range of 1 to 50 ng/mL. The validated assay was then successfully applied to DBS collected as part of a multi-center, dose-escalation study of budesonide administered in surfactant via intra-tracheal instillation to premature neonates between 23 and 28 weeks gestational age. These findings show that DBS are a useful technique for collecting pharmacokinetic samples in premature neonates and other pediatric populations.

Pharmacokinetics of Budesonide Administered with Surfactant in Premature Lambs: Implications for Neonatal Clinical Trials

Bronchopulmonary dysplasia (BPD) is a chronic lung disease of premature human infants, which may persist through adulthood. Airway inflammation has been firmly established in the pathogenesis of BPD. Previous studies to reduce airway inflammation with high-dose dexamethasone demonstrated adverse neurological outcomes, despite lower incidences of BPD. Instillation of budesonide and surfactant can facilitate early extubation and reduce the incidence of BPD and death among very low birth weight infants. However, the pharmacokinetics of budesonide and its distribution into the lung and brain are unknown. Therefore, 5 premature lambs were administered 0.25 mg/kg budesonide, with surfactant as the vehicle. Plasma and tissue samples were taken from the lambs for measurement of budesonide, 16α- hydroxy prednisolone, and budesonide palmitate using LC/MS/MS. Peak plasma budesonide concentrations were inversely correlated with the oxygenation index (correlation coefficient of -0.75). plasma budesonide concentrations were extremely low (~10% of expected) for two lambs that had high oxygenation indices and were excluded from further analyses. For the remaining 5 premature lambs, a non-compartmental analysis demonstrated an AUCinf of 148.77 ± 28.16 h*μg/L, half-life of 4.76 ± 1.79 h, and Cmax of 46.17 ± 17.71 µg/L. Using population pharmacokinetic methods, a onecompartment model with exponential residual error and first-order absorption adequately described the data. The apparent clearance and apparent volume of distribution of budesonide were estimated at 6.29 L/h (1.99 L/h/kg) and 29.1 L (9.2 L/kg), respectively. Budesonide and budesonide palmitate, but not 16α-hydroxy prednisolone, were detected in lung tissue. In this study, budesonide and its metabolites were not detected in the brain, which suggests that intratracheal instillation suggests that after local pulmonary deposition, there is no evidence of budesonide accumulation in the central nervous system. Overall, these results show that peak plasma budesonide concentrations are inversely correlated with the oxygenation index and that lung-specific delivery of budesonide avoids accumulation of budesonide in the brain.

An LC-MS/MS method for the determination of budesonide and 16α-hydroxyprednisolone in dog plasma

Although budesonide is frequently used in veterinary medicine for the treatment of canine respiratory and bowel inflammatory diseases, knowledge is lacking regarding its kinetics in this species. We developed and validated a liquid chromatography–tandem mass spectrometry method for the determination of budesonide and its metabolite 16α-hydroxyprednisolone in dog plasma. The analytes were extracted by solid phase extraction and analysis was performed by high performance liquid chromatography–tandem mass spectrometry, with positive electrospray ionization.•

This method allows budesonide and one of its main metabolites to be simultaneously quantified in dog plasma at fairly low concentrations.

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The proposed protocol is very easy and fast to execute, without compromising analytical performances.

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A small amount (0.5 mL) of plasma is required, making this approach suitable for pharmacokinetic studies also in small sized dogs.

Validated assay for the simultaneous determination of cortisol and budesonide in human plasma using ultra high performance liquid chromatography-tandem mass spectrometry

An ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC/MS/MS) method was developed and validated for the quantification of cortisol and budesonide in human plasma. Charcoal stripped human plasma was used as the blank matrix during validation. Cortisol, budesonide, and dexamethasone (internal standard) were extracted from human plasma with methyl-tert-butyl ether, and the chromatographic separation of the peaks was achieved using a Waters Acquity UPLC BEH C18, 1.7 μm, 2.1 mm × 50 mm column with a run time of 4.0 min. Cortisol, budesonide, and dexamethasone were monitored at the total ion current of their respective multiple reaction monitoring transition signals. The UHPLC/MS/MS system consisted of an Agilent 1290 Infinity ultra high performance liquid chromatograph coupled with an AB Sciex Qtrap(®) 5500 hybrid linear ion-trap triple quadrupole mass spectrometer. The method was validated for accuracy, precision, linearity, range, selectivity, lower limit of quantification (LLOQ), recovery, matrix effect, dilution integrity, and evaluation of carry-over. All validation parameters met the acceptance criteria according to regulatory guidelines. The LLOQ was 1.0 ng/mL for both compounds requiring 100 μL of sample. To our knowledge, this is the first validated LC/MS/MS method for the simultaneous quantitative analysis of cortisol and budesonide in human plasma. The method was applied successfully in a clinical investigation of the impact of nasally administered Pulmicort (budesonide) on the hypothalamic-pituitary-adrenal axis of patients with chronic rhinosinusitis.

Simultaneous quantification of 22R and 22S epimers of budesonide in human plasma by ultra-high-performance liquid chromatography-tandem mass spectrometry: application in a stereoselective pharmacokinetic study

Budesonide (BUD) is used as a mixture of 22R and 22S epimers for the topical treatment of asthma, rhinitis, and inflammatory bowel disease. To study stereoselectivity in the pharmacokinetics of each epimer, we developed a stereoselective and sensitive ultra-high-performance liquid chromatography-tandem mass spectrometry method for the quantitative determination of 22R and 22S epimers of BUD in human plasma. The epimers of BUD were extracted from plasma using n-hexane/dichloromethane/isopropanol (2:1:0.1, v/v/v) under alkaline conditions. Baseline separation was obtained within 7min on an Acquity UPLC BEH C18 (50mm×2.1mm, 1.7μm) column using an isocratic mobile phase consisting of acetonitrile/5mM ammonium acetate/acetic acid (29:71:0.142, v/v/v) at a flow rate of 0.7mL/min. Mass spectrometric detection was performed in a multiple reaction monitoring mode using the m/z 489→357 transition for BUD epimers and the m/z 497→357 transition for the internal standard d8-BUD epimers. Calibration curves were linear over the concentration ranges of 5.0-500 and 5.0-3000pg/mL for 22R-BUD and 22S-BUD, respectively. The lower limit of quantification was 5.0pg/mL for both epimers. The method was successfully applied in a pharmacokinetic study of BUD controlled-release capsules in humans. Consistent differences in the pharmacokinetics of the 22R and 22S epimers were observed, the AUC(0-∞) of 22S-BUD was approximately six times higher than that of 22R-BUD, and the 22S-/22R-BUD ratio of total body clearance was 0.17.

Simultaneous determination of montelukast as sparing therapy with some inhaled corticosteroids in plasma of asthmatic patients

Montelukast (MKST) is a leukotriene receptor antagonist that has been concomitantly used with inhaled corticosteroids (ICS) for its steroid-sparing effect in the long-term management of asthma. However, the simultaneous determination of MKST, when used as ICS tapering therapy, with ICS in human plasma has not yet been reported. A fast and efficient reversed phase monolith HPLC method was developed for simultaneous determination of MKST with some ICS in plasma of asthmatic patients. The separation was achieved on monolith reversed phase column by isocratic mode at a flow rate of 1.0 ml min(-1) using a mobile phase consisted of a mixture of acetonitrile and 10mM phosphate buffer adjusted to pH 3.5 (40:60, v/v) and detected at 240 nm. Betamethasone dipropionate (BDP) was used as the internal standard. All the studied ICS and MKST were efficiently separated within less than 6 min. The obtained linearity range for the developed HPLC method was 0.03-10 μg ml(-1) with correlation coefficients>0.9995 and the detection limits were 0.009-0.016 μg ml(-1) in plasma for all the studied drugs. The method was validated in agreement with the requirements of US-FDA guideline and was recommended for the target applications. The method is valuable for investigations concerned with the effective tapering of ICS therapy with MKST in patients with chronic asthma in clinical practice without loss of asthma control.

Lung effects of inhaled corticosteroids in a rhesus monkey model of childhood asthma

BACKGROUND

The risks for infants and young children receiving inhaled corticosteroid (ICS) therapy are largely unknown. Recent clinical studies indicate that ICS therapy in pre-school children with symptoms of asthma result in decreased symptoms without influencing the clinical disease course, but potentially affect postnatal growth and development. The current study employs a primate experimental model to identify the risks posed by ICS therapy.

OBJECTIVE

To (1) establish whether ICS therapy in developing primate lungs reverses pulmonary pathobiology associated with allergic airway disease (AAD) and (2) define the impact of ICS on postnatal lung growth and development in primates.

METHODS

Infant rhesus monkeys were exposed, from 1 through 6 months, to filtered air (FA) with house dust mite allergen and ozone using a protocol that produces AAD (AAD monkeys), or to FA alone (Control monkeys). From three through 6 months, the monkeys were treated daily with ICS (budesonide) or saline.

RESULTS

Several AAD manifestations (airflow restrictions, lavage eosinophilia, basement membrane zone thickening, epithelial mucin composition) were reduced with ICS treatment, without adverse effects on body growth or adrenal function; however, airway branching abnormalities and intraepithelial innervation were not reduced. In addition, several indicators of postnatal lung growth and differentiation: vital capacity, inspiratory capacity, compliance, non-parenchymal lung volume and alveolarization, were increased in both AAD and Control monkeys that received ICS treatment.

CONCLUSIONS AND CLINICAL RELEVANCE

Incomplete prevention of pathobiological changes in the airways and disruption of postnatal growth and differentiation of airways and lung parenchyma in response to ICS pose risks for developing primate lungs. These responses also represent two mechanisms that could compromise ICS therapy's ability to alter clinical disease course in young children.

Detection of the misuse of steroids in doping control

The list of prohibited substances of the World Anti-Doping Agency (WADA) classifies the administration of several steroids in sports as doping. Their analysis is generally performed using urine specimen as matrix. Lots of the steroids are extensively metabolised in the human body. Thus, knowledge of urinary excretion is extremely important for the sensitive detection of steroid misuse in doping control. The methods routinely used in steroid screening mainly focus on substances, that are excreted unconjugated or as glucuronides. Common procedures include deconjugation using a beta-glucuronidase enzyme. Following extraction and concentration the analytes are submitted to LC-MS(/MS) analysis and/or GC-MS(/MS) analyses. Besides the classical steroids, more and more products appear on the market for "dietary supplements" containing steroids that have never been marketed as approved drugs, mostly without proper labelling of the contents. To cover the whole range of potential products comprehensive screening tools have to be utilised in addition to the classical methods. Endogenous steroids, e.g. testosterone, represent a special group of compounds. As classical chemical methodology is incapable of discriminating synthetic hormones from the biosynthesised congeners, the method of steroid profiling is used for screening purpose. Additionally, based on isotope signatures a discrimination of synthetic and natural hormones can be achieved.

Comparison of electron capture-atmospheric pressure chemical ionization and electrospray ionization for the analysis of gambogic acid and its main circulating metabolite in dog plasma

Gambogic acid (GA), a promising anticancer candidate, is a polyprenylated xanthone abundant in the resin of Garcinia morella and Garcinia hanburyi. Electron capture-atmospheric pressure chemical ionization (EC- APCI) and electrospray ionization (ESI) techniques, both in the negative ion mode, were evaluated regarding ionization, fragmentation patterns and sensitivity for simultaneous liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of GA and its main circulating metabolite, 10-hydroxygambogic acid (10-OHGA) in dog plasma. Both analytes underwent extensive in-source fragmentation in EC-APCI, which was not desirable for reliable quantification of these analytes, whereas the substitution of ESI for EC-APCI almost eliminated the source instability of both analytes. Negative ion ESI was, therefore, chosen for the development of an LC-MS/MS method for simultaneous determination of these analytes. After protein precipitation by acetonitrile, all analytes were separated on a Luna C18 HST column (50 x 2.0 mm i.d., 2.5 microm) with a mobile phase of 20 mmol L(-1) ammonium acetate water solution containing 0.2% acetic acid:acetonitrile (18:82, v/v). The detection was performed on a tandem mass spectrometer using selective reaction monitoring mode. Calibration curves were linear over the range of 10-6000 ng mL(-1) for GA and 3-2000 ng mL(-1) for 10-OHGA. The method was successfully applied to the pharmacokinetics study of GA injection in six beagle dogs.

Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study

OBJECTIVE

Budesonide is an inhaled steroid with a strong topical effect but with minimal systemic effects; it has been effectively delivered to animal lungs using surfactant as a vehicle. The purposes of this study were to determine whether early intratracheal instillation of budesonide using surfactant as a vehicle would improve pulmonary status, reduce mortality, and reduce chronic lung disease morbidity.

PATIENTS AND METHODS

We conducted a prospective, randomized blind trial in 116 very low birth weight infants (< 1500 g) who had severe radiographic respiratory distress syndrome and required mechanical ventilation with fraction of inspired oxygen > or = 0.6 shortly after birth: 60 were in the treated group (intratracheal instillation of a mixture of 0.25 mg/kg of budesonide and 100.00 mg/kg of survanta, every 8 hours) and 56 were in the control group (100 mg/kg of survanta only, every 8 hours). The end point assessment was the number of infants who would die or develop chronic lung disease at 36 weeks' postconceptional age.

RESULTS

Infants in the treatment group required significantly lower mean airway pressure on day 1 and day 3 and had significantly lower oxygen index and PCO(2) during the first 3 days than infants in the control group. More infants were extubated in the treatment group than controls at 1 and 2 weeks. The combined outcome of deaths or chronic lung disease was significantly lower in the treatment group than in the control group (19 of 60 vs 34 of 56). No clinically significant adverse effects were observed during the study.

CONCLUSIONS

This pilot study indicated that early postnatal intratracheal instillation of budesonide using surfactant as vehicle significantly improved the combined outcome of death or chronic lung disease in small premature infants without causing immediate adverse effects. The results are encouraging, and a large sample multicenter trial is warranted.

Detection of budesonide in human urine after inhalation by liquid chromatography-mass spectrometry

Budesonide, a corticosteroid frequently used in the treatment of asthma, is most often administered via inhalation. Its use in sports is allowed when medically necessary. A fast, sensitive and accurate LC-MS method was developed and validated for the quantification of budesonide and its major metabolite 16alpha-hydroxyprednisolone in urine samples after inhalation of a metered dose (Pulmicort-Turbohaler 200). Sample preparation consists of an alkaline liquid-liquid extraction with ethyl acetate. Analysis was performed using liquid chromatography-tandem mass spectrometry with electrospray ionization (ESI). The method was linear in the range of 5-100 and 0.5-10ng/mL for 16alpha-hydroxyprednisolone and budesonide, respectively. The limits of quantification were 5ng/ml for 16alpha-hydroxyprednisolone and 0.5ng/mL for budesonide. The accuracy ranged from 2.2 to 3.5% for 16alpha-hydroxyprednisolone and from 0.8 to 16.4% for budesonide. After administration of 200microg of budesonide to five healthy volunteers budesonide could not be detected in any urine sample whereas 16alpha-hydroxyprednisolone was detectable up to 12h post-administration.

Multidrug resistance 1 genotype and disposition of budesonide in early primary biliary cirrhosis

BACKGROUND

Budesonide, which is a dual substrate of P-glycoprotein, the product of the multidrug resistance 1 (MDR1) gene, and cytochrome P450 3A (CYP3A) has been proposed for treatment of early primary biliary cirrhosis (PBC). Recently, MDR1 gene polymorphisms have been discussed as a potential cause of glucocorticoid resistance. We tested the hypothesis that MDR1 gene polymorphisms affect absorption of oral budesonide.

METHODS

In 21 patients with histologically proven early-stage (I/II) PBC and nine healthy subjects, we evaluated the impact of MDR1 single nucleotide polymorphisms (2,677G>T,A and 3,435C>T) on disposition of a single oral dose of 3 mg budesonide. CYP3A5 gene polymorphisms (6,986A>G) were analyzed in parallel.

RESULTS

In MDR1 2,677 GG and 3,435 CC genotypes, absorption and elimination of budesonide were not significantly different from those in corresponding homozygous variants. Peak plasma levels and areas under the plasma concentration time curves (AUC) of budesonide were not lower in MDR1 3,435 CC with putatively high intestinal expression of P-glycoprotein than in MDR1 3,435 TT. Interestingly, in two CYP3A5*1/*3 carriers with high enzyme activity, lower AUC was noted than in 28 CYP3A5*3/*3 carriers with a deficient enzyme.

CONCLUSION

Common MDR1 gene polymorphisms do not affect disposition of budesonide in early PBC.

Pharmacokinetics and pharmacodynamic action of budesonide in children with Crohn's disease

BACKGROUND

Budesonide is effective as initial therapy of mild to moderate Crohn's disease in adults. Superior tolerability to conventional corticosteroids might be attributed to extensive first-pass metabolism of budesonide by cytochrome P450 3A.

AIM

To evaluate biotransformation and pharmacodynamic action of budesonide in children.

METHODS

Drug disposition and effects on endogenous cortisol were evaluated in 12 children with Crohn's disease (5-15 years) after first intake of 3 mg budesonide (single dose), and again after 1 week of thrice daily dosing (steady-state). The parent drug and cytochrome P450 3A-dependent metabolites were analysed in blood and urine.

RESULTS

Pharmacokinetic parameters of budesonide following single-dose administration (e.g. AUC(0-infinity) 7.7+/-5.1 h ng/mL, C(max) 1.8+/-1.2 ng/mL) did not change upon multiple dosing. Overall systemic elimination of budesonide reflected by clearance and half-life was not different between children and adults. After 1 week of treatment reversible adrenal suppression was observed - most pronounced in children aged below 12 years.

CONCLUSIONS

Disposition of oral budesonide appears to be similar between children and adults, but the doctor has to be aware of an increased risk for adrenal suppression in paediatric patients.