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Sicard R, Oleru O, Doan J, Seyidova N, Taub PJ. Efficacy and dosing of indocyanine green in pediatric plastic and reconstructive surgery. Microsurgery 2024; 44:e31188. [PMID: 38798124 DOI: 10.1002/micr.31188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Ryan Sicard
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Olachi Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jared Doan
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Pio L, Wijnen MHWA, Giuliani S, Sarnacki S, Davidoff AM, Abdelhafeez AH. Identification of Pediatric Tumors Intraoperatively Using Indocyanine Green (ICG). Ann Surg Oncol 2023; 30:7789-7798. [PMID: 37543553 DOI: 10.1245/s10434-023-13953-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Fluorescence-guided surgery (FGS) with indocyanine green (ICG) is increasingly applied in pediatric surgical oncology. However, FGS has been mostly reported in case studies of liver or renal tumors. Applying novel technologies in pediatric surgical oncology is more challenging than in adult surgical oncology due to differences in tumor histology, biology, and fewer cases. No consensus exists on ICG-guided FGS for surgically managing pediatric solid tumors. Therefore, we reviewed the literature and discuss the limitations and prospects of FGS. METHODS Using PRISMA guidelines, we analyzed articles on ICG-guided FGS for childhood solid tumors. Case reports, opinion articles, and narrative reviews were excluded. RESULTS Of the 108 articles analyzed, 17 (14 retrospective and 3 prospective) met the inclusion criteria. Most (70.6%) studies used ICG to identify liver tumors, but the timing and dose of ICG administered varied. Intraoperative outcomes, sensitivity and specificity, were reported in 23.5% of studies. Fluorescence-guided liver resections resulted in negative margins in 90-100% of cases; lung metastasis was detected in 33% of the studies. In otolaryngologic malignancies, positive margins without fluorescence signal were reported in 25% of cases. Overall, ICG appeared effective and safe for lymph node sampling and nephron-sparing procedures. CONCLUSIONS Despite promising results from FGS, ICG use varies across the international pediatric surgical oncology community. Underreported intraoperative imaging outcomes and the diversity and rarity of childhood solid tumors hinder conclusive scientific evidence supporting adoption of ICG in pediatric surgical oncology. Further international collaborations are needed to study the applications and limitations of ICG in pediatric surgical oncology.
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Affiliation(s)
- Luca Pio
- Department of Surgery, MS133, St. Jude Children's Researsch Hospital, Memphis, TN, USA
- Learning Planet Institute, Université de Paris, Paris, France
| | - Marc H W A Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Stefano Giuliani
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Cancer Section, Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Necker-Enfants Malades Hospital, GH Centre, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - Andrew M Davidoff
- Department of Surgery, MS133, St. Jude Children's Researsch Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS133, St. Jude Children's Researsch Hospital, Memphis, TN, USA.
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Hamimed M, Gattacceca F, André N, Tresch-Bruneel E, Probst A, Chastagner P, Pagnier A, De Carli E, Entz-Werlé N, Grill J, Aerts I, Frappaz D, Bertozzi-Salamon AI, Solas C, Leblond P. Pharmacokinetics of oral vinorelbine in French children with recurrent or progressive primary low-grade glioma. Br J Clin Pharmacol 2021; 88:2096-2117. [PMID: 34709655 DOI: 10.1111/bcp.15131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022] Open
Abstract
AIM There is a crucial need for pharmacokinetic (PK) data of oral vinorelbine (VNR) in pediatric population. The aim of this work was to assess the PK profile of orally administered VNR in children with recurrent/progressive primary low-grade glioma (LGG). METHODS A multicentric, open-label, single-arm intervention phase II study was conducted. Patients, aged between 6 and 18 years, with histologically confirmed recurrent or progressive primary LGG or non-documented typical optic pathway tumors, were included. PK parameters were estimated by non-compartmental analysis using Phoenix WinNonlin® software (version 8.0, Certara, Inc.). The Influence of demographic and biological covariates on VNR PK parameters was investigated using a multivariate linear regression analysis. RESULTS PK analysis included 36 patients with a median age (range) of 11 (6-17) years. Estimates of apparent oral clearance (CL/F), apparent volume of distribution (V/F), half-life (t1/2 ) and their between-subject variability (CV%) at 60 mg.m-2 dose level, were 472 L.h-1 (51.8%), 7002 L (57.9%) and 10 h (21.0%), respectively. Negligible accumulation of VNR between C1 and C2 was observed. CL/F and V/F were found to increase with body surface area (BSA) (p = 0.004). Lower area under the concentration-time curve (AUC) levels were observed among children in comparison to adults. CONCLUSION Higher doses may be necessary for children with LGG. BSA showed a significant impact on VNR systemic exposure. We believe that our findings will serve as a basis for further studies to better characterize the concentration-response relationships of VNR among pediatric patients.
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Affiliation(s)
- Mourad Hamimed
- SMARTc Unit, Cancer Research Center of Marseille, Inserm U1068 - CNRS UMR 7258 - Aix-Marseille University U105, Marseille, France.,Inria - Inserm COMPO team, Centre Inria Sophia Antipolis - Méditerranée, Inserm U1068 - CNRS UMR 7258 - Aix-Marseille University U105, Marseille, France
| | - Florence Gattacceca
- SMARTc Unit, Cancer Research Center of Marseille, Inserm U1068 - CNRS UMR 7258 - Aix-Marseille University U105, Marseille, France.,Inria - Inserm COMPO team, Centre Inria Sophia Antipolis - Méditerranée, Inserm U1068 - CNRS UMR 7258 - Aix-Marseille University U105, Marseille, France
| | - Nicolas André
- SMARTc Unit, Cancer Research Center of Marseille, Inserm U1068 - CNRS UMR 7258 - Aix-Marseille University U105, Marseille, France.,Department of Pediatric Oncology, La Timone University Hospital of Marseille, APHM, Marseille, France
| | | | - Alicia Probst
- Département de la Recherche Clinique et Innovation,Oscar Lambret Cancer Center, Lille, France
| | - Pascal Chastagner
- Service d'hémato-oncologie pédiatrique, Nancy University Hospital, Nancy, France
| | - Anne Pagnier
- Service d'hémato-oncologie pédiatrique, Grenoble University Hospital, Grenoble, France
| | - Emilie De Carli
- Service d'hémato-oncologie pédiatrique, Angers University Hospital, Angers, France
| | - Natacha Entz-Werlé
- Pédiatrie Onco-Hématologie Université de Strasbourg, CHRU Hautepierre- - UMR CNRS 7021, Strasbourg, France
| | - Jacques Grill
- Département de Cancérologie de l'Enfant et de l'Adolescent et UMR CNRS 8203 Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - Isabelle Aerts
- SIREDO Centre (Care, innovation and research in paediatric, adolescent and young adult oncology), Institut Curie- Oncology Center, Paris, France
| | - Didier Frappaz
- Institute of Pediatric Hematology and Oncology IHOPe, Léon Bérard Cancer Center, Lyon, France
| | | | - Caroline Solas
- Unité des Virus Émergents (UVE), Aix-Marseille Univ-IRD 190-Inserm 1207, Marseille, France.,Clinical Pharmacokinetics and Toxicology Laboratory, La Timone University Hospital of Marseille, APHM, Marseille, France
| | - Pierre Leblond
- Institute of Pediatric Hematology and Oncology IHOPe, Léon Bérard Cancer Center, Lyon, France.,Department of Pediatric Oncology, Oscar Lambret Cancer Center, Lille, France
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4
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Abdelhafeez A, Talbot L, Murphy AJ, Davidoff AM. Indocyanine Green-Guided Pediatric Tumor Resection: Approach, Utility, and Challenges. Front Pediatr 2021; 9:689612. [PMID: 34616696 PMCID: PMC8489593 DOI: 10.3389/fped.2021.689612] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Incomplete tumor resection increases the risk of local recurrence. However, the standard of care approach to distinguishing tumor tissue is less than optimal, as it depends on a conglomeration of preoperative imaging and visual and tactile indicators in real time. This approach is associated with a significant risk of inadequate resection; therefore, a novel approach that delineates the accurate intraoperative definition of pediatric tumors is urgently needed. To date, there is no reliable method for the intraoperative assessment of tumor extent and real-time differentiation between tumor- involved tissues and tumor-free tissues. Use of intraoperative frozen sections is challenging, time consuming, and covers a small surface area. Increased vascular permeability and impaired lymphatic drainage in the tumor microenvironment leads to an enhanced permeability and retention effect of small molecules. ICG is a fluorescent dye that when administered intravenously accumulates passively in the tumor because of EPR, thereby providing some tumor contrast for intraoperative real-time tumor recognition. Preclinical and clinical studies suggest that the tumor-to-background fluorescence ratio is optimized when imaging is obtained 24 h after dye injection, and many studies suggest using a high dose of ICG to optimize dye retention in the tumor tissue. However, in childhood cancers, little is known about the ideal dosing, applications, and challenges of ICG-guided tumor resection. This retrospective study examines the feasibility of ICG-guided tumor resection in common childhood solid tumors such as neuroblastoma, sarcomas, hepatic tumors, pulmonary metastases, and other rare tumors. Pediatric dosing and challenges related to the optimization of tumor-to-background ratio are also examined.
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Affiliation(s)
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children Research Hospital, Memphis, TN, United States
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children Research Hospital, Memphis, TN, United States
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children Research Hospital, Memphis, TN, United States
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Intravenous Thrombolysis at 3.5 Hours From Onset of Pediatric Acute Ischemic Stroke. Pediatr Emerg Care 2020; 36:e4-e7. [PMID: 29406476 PMCID: PMC6077109 DOI: 10.1097/pec.0000000000001419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute thrombolysis has a proven benefit for adults presenting with acute ischemic stroke, but data within the pediatric population are extremely limited. We report the case of a 14-year-old girl who presented with right-sided weakness and ataxia, loss of sensation, and altered mental status. Magnetic resonance imaging with diffusion-weighted imaging showed an acute lesion in the distribution of the left posterior cerebral artery, and magnetic resonance angiogram demonstrated occlusion of the third branch of the left posterior cerebral artery. With parental consent, clinicians decided to infuse an adult dose of weight-adjusted intravenous alteplase at 3.5 hours from onset of symptoms, with subsequent improvement in National Institutes of Health Stroke Scale score from 11 to 3. Computed tomography angiogram at 24 hours showed recanalization of the occluded vessel with no evidence of intracranial hemorrhage. Stroke Scale score at discharge was 3, with modified Rankin Scale scores at discharge of 1 and at 90 days of 0. This case highlights the importance of magnetic resonance imaging in diagnosing pediatric acute ischemic stroke and suggests consideration of thrombolysis in select confirmed pediatric stroke cases. However, a rigorous evidence base is lacking, and clinical trials have not been successful in recruiting patients.
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6
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Clearance of Indocyanine Green in Severe Pediatric Burns. J Trauma Acute Care Surg 2018; 86:817-822. [PMID: 30589752 DOI: 10.1097/ta.0000000000002180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clearance of indocyanine green dye (ICGc) reflects sinusoidal perfusion and hepatocyte cell membrane function. Thus, ICGc is a reflection of the functional reserve of intact hepatocytes. The purpose of this study was to identify predictors of ICGc in severely burned children during the acute hospitalization and at the time of discharge from the intensive care unit (ICU). A secondary aim was to determine the relationship between liver size and patient ICGc. METHODS Twenty-six children (0.8-17 years old) with 35% or greater total body surface area burned (%TBSA-B) were included. Assessment of ICGc (in milliliters per minute per meter squared) was done during the acute hospitalization (median: 6 days after admission, median: 14 days postburn) and at the time of discharge from the ICU (median: 19 days after admission, median: 27 days postburn). Age, TBSA-B, % third-degree burns, inhalation injury, preexisting chronic malnutrition, hematocrit, liver dysfunction, and time from burn injury were incorporated in multiple linear regressions as predictive variables of ICGc. Only variables with p < 0.05 were retained in the final models. RESULTS Time from injury and age were the strongest predictors of ICGc during the acute admission but not at the time of discharge from the ICU. Time from injury was negatively associated with ICGc, whereas age was positively associated. At the time of discharge from the ICU, ICGc was increased in proportion to the %TBSA-B, whereas inhalation injury and preexisting chronic malnutrition were associated with lower ICGc. There was no correlation between change-to-predicted liver length and ICGc. CONCLUSIONS The intrinsic ability of the liver to extract ICG from plasma was lower in younger burned patients during the acute admission and in those with preexisting chronic malnutrition and inhalation injury at the time of discharge from the ICU. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level III.
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Bhogal P, Hellstern V, AlMatter M, Ganslandt O, Bäzner H, Aguilar Pérez M, Henkes H. Mechanical thrombectomy in children and adolescents: report of five cases and literature review. Stroke Vasc Neurol 2018; 3:245-252. [PMID: 30637131 PMCID: PMC6312071 DOI: 10.1136/svn-2018-000181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background Paediatric arterial ischaemic stroke is an important cause of morbidity and mortality among children. Currently, there are no recommendations regarding mechanical thrombectomy in children despite overwhelming evidence of improved outcomes in adults. Therefore, the need for individual case reports and case series is important to highlight potential advantages and disadvantages in this approach. Case descriptions We retrospectively searched our prospectively maintained database of patients undergoing mechanical thrombectomy for ischaemic stroke. We describe five children, aged between 7 and 17, who underwent mechanical thrombectomy for acute ischaemic stroke. We provide an account of their clinical presentations, operative treatment and postoperative outcome. Discussion Mechanical thrombectomy in children, especially older children, can be performed safely and with existing devices. Although a randomised controlled trial would provide compelling evidence of the potential advantages to this technique, the lack of this should not prevent the use of this procedure by trained neurointerventionists.
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Affiliation(s)
- Pervinder Bhogal
- Department of Interventional Neuroradiology, Royal London Hospital, London, UK
| | - Victoria Hellstern
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Muhammad AlMatter
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Oliver Ganslandt
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Hansjörg Bäzner
- Neurosurgical Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Marta Aguilar Pérez
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Duisburg, Germany
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Vanhove T, Annaert P, Kuypers DRJ. Clinical determinants of calcineurin inhibitor disposition: a mechanistic review. Drug Metab Rev 2016; 48:88-112. [DOI: 10.3109/03602532.2016.1151037] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, Gill JC, Szabo A, Hill MD, Scholz K, Amlie-Lefond C. Thrombolysis in pediatric stroke study. Stroke 2015; 46:880-5. [PMID: 25613306 DOI: 10.1161/strokeaha.114.008210] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael J Rivkin
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Gabrielle deVeber
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Rebecca N Ichord
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Adam Kirton
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Anthony K Chan
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Collin A Hovinga
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Joan Cox Gill
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Aniko Szabo
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Michael D Hill
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Kelley Scholz
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
| | - Catherine Amlie-Lefond
- From the Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, and Department of Neurology, Harvard Medical School, Boston, MA (M.J.R.); Division of Neurology, Department of Pediatrics, Hospital for Sick Children Toronto, Ontario, Canada (G.d.V.); The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.N.I.); Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada Alberta Children's Hospital (A.K.) and Department of Clinical Neurosciences and Hotchkiss Brain Institute (M.D.H.), University of Calgary, Alberta, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.C.); Dell Children's Medical Center and University of Texas at Austin College of Pharmacy (C.A.H.); BloodCenter of Wisconsin and Department of Pediatrics (J.C.G.) and Division of Biostatistics (A.S.), Medical College of Wisconsin, Milwaukee; Center for Integrated Brain Research, Seattle Children's Research Institute, WA (K.S.); and Seattle Children's Hospital, Department of Neurology, University of Washington, Seattle (C.A.-L.)
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10
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Effects of body size and gender on the population pharmacokinetics of artesunate and its active metabolite dihydroartemisinin in pediatric malaria patients. Antimicrob Agents Chemother 2013; 57:5889-900. [PMID: 24041884 DOI: 10.1128/aac.00635-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite the important role of the antimalarial artesunate and its active metabolite dihydroartemisinin (DHA) in malaria treatment efforts, there are limited data on the pharmacokinetics of these agents in pediatric patients. This study evaluated the effects of body size and gender on the pharmacokinetics of artesunate-DHA using data from pediatric and adult malaria patients. Nonlinear mixed-effects modeling was used to obtain a base model consisting of first-order artesunate absorption and one-compartment models for artesunate and for DHA. Various methods of incorporating effects of body size descriptors on clearance and volume parameters were tested. An allometric scaling model for weight and a linear body surface area (BSA) model were deemed optimal. The apparent clearance and volume of distribution of DHA obtained with the allometric scaling model, normalized to a 38-kg patient, were 63.5 liters/h and 65.1 liters, respectively. Estimates for the linear BSA model were similar. The 95% confidence intervals for the estimated gender effects on clearance and volume parameters for artesunate fell outside the predefined no-relevant-clinical-effect interval of 0.75 to 1.25. However, the effect of gender on apparent DHA clearance was almost entirely contained within this interval, suggesting a lack of an influence of gender on this parameter. Overall, the pharmacokinetics of artesunate and DHA following oral artesunate administration can be described for pediatric patients using either an allometric scaling or linear BSA model. Both models predict that, for a given artesunate dose in mg/kg of body weight, younger children are expected to have lower DHA exposure than older children or adults.
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11
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Cui JY, Gunewardena SS, Yoo B, Liu J, Renaud HJ, Lu H, Zhong XB, Klaassen CD. RNA-Seq reveals different mRNA abundance of transporters and their alternative transcript isoforms during liver development. Toxicol Sci 2012; 127:592-608. [PMID: 22454430 DOI: 10.1093/toxsci/kfs107] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
During development, the maturation of liver transporters is essential for chemical elimination in newborns and children. One cannot compare the real abundance of transcripts by conventional messenger RNA (mRNA) profiling methods; in comparison, RNA-Seq provides a "true quantification" of transcript counts and an unbiased detection of novel transcripts. The purpose of this study was to compare the mRNA abundance of liver transporters and seek their novel transcripts during liver development. Livers from male C57BL/6J mice were collected at 12 ages from prenatal to adulthood. The transcriptome was determined by RNA-Seq, with transcript abundance estimated by Cufflinks. Among 498 known transporters, the ontogeny of 62 known critical xenobiotic transporters was examined in detail. The cumulative mRNAs of the uptake transporters increased more than the efflux transporters in livers after birth. A heatmap revealed three ontogenic patterns of these transporters, namely perinatal (reaching maximal expression before birth), adolescent (about 20 days), and adult enriched (about 60 days of age). Before birth, equilibrative nucleoside transporter 1 was the transporter with highest expression in liver (29%), followed by breast cancer resistance protein (Bcrp) (26%). Within 1 day after birth, the mRNAs of these two transporters decreased markedly, and Ntcp became the transporter with highest expression (52%). In adult liver, the transporters with highest expression were organic cation transporter 1 and Ntcp (23% and 22%, respectively). Three isoforms of Bcrp with alternate leading exons were identified (E1a, E1b, and E1c), with E1b being the major isoform. In conclusion, this study reveals the mRNA abundance of transporters in liver and demonstrates that the expression of liver transporters is both age and isoform specific.
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Affiliation(s)
- Julia Yue Cui
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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12
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Estimation of indocyanine green elimination rate constant k and retention rate at 15 min using patient age, weight, bilirubin, and albumin. ACTA ACUST UNITED AC 2009; 16:521-8. [DOI: 10.1007/s00534-009-0097-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Accepted: 12/07/2008] [Indexed: 12/14/2022]
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Albers S, Meibohm B, Mir TS, Läer S. Population pharmacokinetics and dose simulation of carvedilol in paediatric patients with congestive heart failure. Br J Clin Pharmacol 2007; 65:511-22. [PMID: 17995971 DOI: 10.1111/j.1365-2125.2007.03046.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Applying in silico tools such as population pharmacokinetic analysis and simulation will help to find adequate dosing strategies and increase the probability of success for a randomized controlled trial. * Up to now, for carvedilol in paediatric patients with congestive heart failure (CHF) the dose has been linearly extrapolated from adults, but the results with this dosing strategy are ambiguous. * Further trials are necessary to establish carvedilol for paediatric patients with CHF. WHAT THIS STUDY ADDS * Carvedilol pharmacokinetics in paediatric patients with CHF depends on the weight and age of the patient. * Therefore, the drug exposure differs substantially between patients of different ages receiving the same dose with respect to body weight. * Simulations revealed that an age-adjusted carvedilol dosing strategy with higher doses for younger patients with respect to body weight is preferable to a uniform one. AIMS To investigate the ontogeny of carvedilol pharmacokinetics and to develop an age-appropriate carvedilol dosing strategy for paediatric patients. METHODS Data were derived from a prospective, nonplacebo-controlled study of carvedilol for the treatment of paediatric patients with congestive heart failure and analysed using a nonlinear mixed-effects modelling approach (NONMEM, Version V 1.1). The population pharmacokinetic model was further utilized for simulations of different carvedilol dosing strategies. RESULTS Four hundred and eighty carvedilol plasma concentrations of 41 patients (0.1-19.3 years; median 3.5) were included in the analysis. A two-compartment model with first-order absorption and absorption lag served as structural model. Weight and age were the most important covariates for carvedilol pharmacokinetics. The weight-adjusted clearance was highest for the younger patients with 2.7 l h(-1) kg(-1) for a 1-year-old patient compared with 0.7 l h(-1) kg(-1) for a 19.3-year-old patient. Dose simulations revealed that the area under the plasma concentration-time curve (AUC) as a measure of drug exposure increased with age despite constant doses with respect to body weight. For infants (28 days to 23 months), children (2-11 years) and adolescents (12-15 years) daily doses of 3, 2 and 1 mg kg(-1), administered in two or three discrete doses, were necessary to reach an exposure comparable to adults receiving 0.7 mg kg(-1) day(-1). CONCLUSION The ontogeny of carvedilol pharmacokinetics in paediatric patients depends on age and weight. Dose simulations revealed that younger patients have to be treated with higher doses with respect to body weight to reach the same exposure as adults.
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Affiliation(s)
- Stefanie Albers
- Clinical Pharmacology and Pharmacotherapy, University of Düsseldorf, Germany
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Bartelink IH, Rademaker CMA, Schobben AFAM, van den Anker JN. Guidelines on paediatric dosing on the basis of developmental physiology and pharmacokinetic considerations. Clin Pharmacokinet 2007; 45:1077-97. [PMID: 17048973 DOI: 10.2165/00003088-200645110-00003] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The approach to paediatric drug dosing needs to be based on the physiological characteristics of the child and the pharmacokinetic parameters of the drug. This review summarises the current knowledge on developmental changes in absorption, distribution, metabolism and excretion and combines this knowledge with in vivo and in vitro pharmacokinetic data that are currently available. In addition, dosage adjustments based on practical problems, such as child-friendly formulations and feeding regimens, disease state, genetic make-up and environmental influences are presented. Modification of a dosage based on absorption, depends on the route of absorption, the physico chemical properties of the drug and the age of the child. For oral drug absorption, a distinction should be made between the very young and children over a few weeks old. In the latter case, it is likely that practical considerations, like appropriate formulations, have much greater relevance to oral drug absorption. The volume of distribution (V(d)) may be altered in children. Hydrophilic drugs with a high V(d) in adults should be normalised to bodyweight in young children (age <2 years), whereas hydrophilic drugs with a low V(d) in adults should be normalised to body surface area (BSA) in these children. For drugs that are metabolised by the liver, the effect of the V(d) becomes apparent in children <2 months of age. In general, only the first dose should be based on the V(d); subsequent doses should be determined by the clearance. Pharmacokinetic studies on renal and liver function clarify that a distinction should be made between maturation and growth of the organs. After the maturation process has finished, the main influences on the clearance of drugs are growth and changes in blood flow of the liver and kidney. Drugs that are primarily metabolised by the liver should be administered with extreme care until the age of 2 months. Modification of dosing should be based on response and on therapeutic drug monitoring. At the age of 2-6 months, a general guideline based on bodyweight may be used. After 6 months of age, BSA is a good marker as a basis for drug dosing. However, even at this age, drugs that are primarily metabolised by cytochrome P450 2D6 and uridine diphosphate glucuronosyltransferase should be normalised to bodyweight. In the first 2 years of life, the renal excretion rate should be determined by markers of renal function, such as serum creatinine and p-aminohippuric acid clearance. A dosage guideline for drugs that are significantly excreted by the kidney should be based on the determination of renal function in first 2 years of life. After maturation, the dose should be normalised to BSA. These guidelines are intended to be used in clinical practice and to form a basis for more research. The integration of these guidelines, and combining them with pharmacodynamic effects, should be considered and could form a basis for further study.
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Affiliation(s)
- Imke H Bartelink
- Department of Pharmacy, University Medical Center, Utrecht, The Netherlands.
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Björkman S. Prediction of drug disposition in infants and children by means of physiologically based pharmacokinetic (PBPK) modelling: theophylline and midazolam as model drugs. Br J Clin Pharmacol 2005; 59:691-704. [PMID: 15948934 PMCID: PMC1884855 DOI: 10.1111/j.1365-2125.2004.02225.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 06/18/2004] [Indexed: 11/26/2022] Open
Abstract
AIMS To create a general physiologically based pharmacokinetic (PBPK) model for drug disposition in infants and children, covering the age range from birth to adulthood, and to evaluate it with theophylline and midazolam as model drugs. METHODS Physiological data for neonates, 0.5-, 1-, 2-, 5-, 10- and 15-year-old children, and adults, of both sexes were compiled from the literature. The data comprised body weight and surface area, organ weights, vascular and interstitial spaces, extracellular body water, organ blood flows, cardiac output and glomerular filtration rate. Tissue: plasma partition coefficients were calculated from rat data and unbound fraction (f u) of the drug in human plasma, and age-related changes in unbound intrinsic hepatic clearance were estimated from CYP1A2 and CYP2E1 (theophylline) and CYP3A4 (midazolam) activities in vitro. Volume of distribution (V dss), total and renal clearance (CL and CL R) and elimination half-life (t(1/2)) were estimated by PBPK modelling, as functions of age, and compared with literature data. RESULTS The predicted V dss of theophylline was 0.4-0.6 l kg(-1) and showed only a modest change with age. The median prediction error (MPE) compared with literature data was 3.4%. Predicted total CL demonstrated the time-course generally reported in the literature. It was 20 ml h(-1) kg(-1) in the neonate, rising to 73 ml h(-1) kg(-1) at 5 years and then decreasing to 48 ml h(-1) kg(-1) in the adult. Overall, the MPE was - 4.0%. Predicted t(1/2) was 18 h in the neonate, dropping rapidly to 4.6-7.2 h from 6 months onwards, and the MPE was 24%. The predictions for midazolam were also in good agreement with literature data. V dss ranged between 1.0 and 1.7 l kg(-1) and showed only modest change with age. CL was 124 ml h(-1) kg(-1) in the neonate and peaked at 664 ml h(-1) kg(-1) at 5 years before decreasing to 425 ml h(-1) kg(-1) in the adult. Predicted t(1/2) was 6.9 h in the neonate and attained 'adult' values of 2.5-3.5 h from 1 year onwards. CONCLUSIONS A general PBPK model for the prediction of drug disposition over the age range neonate to young adult is presented. A reference source of physiological data was compiled and validated as far as possible. Since studies of pharmacokinetics in children present obvious practical and ethical difficulties, one aim of the work was to utilize maximally already available data. Prediction of the disposition of theophylline and midazolam, two model drugs with dissimilar physicochemical and pharmacokinetic characteristics, yielded results that generally tallied with literature data. Future use of the model may demonstrate further its strengths and weaknesses.
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Affiliation(s)
- Sven Björkman
- Hospital Pharmacy, Malmö University Hospital, Malmö and Division of Pharmacokinetics and Drug Therapy, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
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Petersen KB, Jusko WJ, Rasmussen M, Schmiegelow K. Population pharmacokinetics of prednisolone in children with acute lymphoblastic leukemia. Cancer Chemother Pharmacol 2003; 51:465-73. [PMID: 12698270 DOI: 10.1007/s00280-003-0602-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2002] [Accepted: 02/12/2003] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the plasma protein binding and pharmacokinetics of prednisolone during therapeutic use in children with acute lymphoblastic leukemia (ALL) using the population approach. METHODS A two-compartment pharmacokinetic model was used to describe data from 23 children with ALL (aged 2-15 years). Prednisolone (60 mg/m(2) per day in three divided doses) was administered both orally and intravenously, and samples were obtained on several days during the initial 5 weeks of remission induction therapy. Unbound plasma concentrations ( n=288) were determined by HPLC and ultrafiltration. Nonlinear mixed-effects modeling (WinNonMix version 2.0.1) was used to estimate the pharmacokinetic parameters, to identify significant covariates, and to estimate the protein binding parameters. RESULTS Prednisolone showed complete oral bioavailability. The median unbound clearance (32 l/h per m(2)) was lower, and the half-life (3.6 h) longer than previously reported in childhood ALL. Body weight was a significant covariate for the central and peripheral volumes of distribution resulting in interindividual variabilities of 50% and 42%. Including body surface area as a covariate for clearance decreased the interindividual variability to 14%. The estimated areas under the unbound plasma concentration-time curves showed less than twofold variation among patients, and a residual variability of 20% indicated that the pharmacokinetic parameters remained stable during induction therapy. The estimated protein binding parameters were comparable to, but slightly lower than, previously published values and independent of the albumin concentration. CONCLUSIONS The study showed complete oral bioavailability, a lower unbound clearance and a longer half-life for prednisolone than previously reported in childhood ALL. Plasma protein binding was independent of the albumin concentration. Due to the small inter- and intraindividual variations in the pharmacokinetic parameters, body surface area-based dosing is sufficient to obtain similar systemic exposure among patients.
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Affiliation(s)
- Kamilla B Petersen
- Department of Pharmaceutics, The Danish University of Pharmaceutical Sciences, Copenhagen, Denmark
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17
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Hassan M, Nilsson C, Hassan Z, Gungor T, Aschan J, Winiarski J, Hentschke P, Ringdén O, Eber S, Seger R, Ljungman P. A phase II trial of liposomal busulphan as an intravenous myeloablative agent prior to stem cell transplantation: 500 mg/m(2) as a optimal total dose for conditioning. Bone Marrow Transplant 2002; 30:833-41. [PMID: 12476274 DOI: 10.1038/sj.bmt.1703739] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2002] [Accepted: 07/08/2002] [Indexed: 11/09/2022]
Abstract
We conducted a phase I/II trial, to evaluate the efficacy and safety of an intravenous liposomal formulation of busulphan (LBu) as a myeloablative agent for stem cell transplantation (SCT). The liposomal busulphan was administered as a 3 h infusion twice daily over 4 consecutive days. Six adults received 1.6-2 mg/kg/dose and 18 children received 1.8-3 mg/kg/dose. Pharmacokinetic parameters were studied after the first and the last dose of busulphan. No significant difference in clearance, AUC, elimination half-lives or distribution volume between the first and the last dose was found in either groups. A significantly (P < 0.005) higher clearance was observed in children after the first and the last dose (3.61 and 3.79 ml/min/kg, respectively) compared to adults (2.40 and 2.33 ml/min/kg, respectively). The elimination half-lives after the first and the last dose were significantly (P < 0.005) shorter in children (2.59 and 2.72 h, respectively) compared to adults (3.35 and 3.61 h, respectively). Clearance correlated significantly with age. However, no significant correlation with age was observed when clearance was adjusted to the body surface area. Two cases of VOD following a total dose of 24 mg/kg were observed. Six patients experienced mucositis. No other organ toxicity was observed. We conclude that intravenous liposomal busulphan pharmacokinetics is age dependent. A dosage schedule based on body surface area should be used especially in young children to reduce the age-dependent difference in kinetics. An intravenous liposomal dose of busulphan of 500 mg/m(2) is suggested to reach a similar systemic exposure and myeloablative effect in both children and adults. Moreover, the novel liposomal form of busulphan showed a favorable toxicity profile and seems safe as a part of the high-dose therapy prior to SCT.
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Affiliation(s)
- M Hassan
- Laboratory of Hematology, Division of Hematology, Department of Medicine, Huddinge University Hospital, Stockholm, Sweden
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18
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Abstract
Dramatic developmental changes in the physiological and biochemical processes that govern drug pharmacokinetics and pharmacodynamics occur during the first year of life. These changes may have significant consequences for the way infants respond to and deal with drugs. The ontogenesis of systemic clearance mechanisms is probably the most critical determinant of a pharmacological response in the developing infant. In recent years, advances in molecular techniques and an increased availability of fetal and infant tissues have afforded enhanced insight into the ontogeny of clearance mechanisms. Information from these studies is reviewed to highlight the dynamic and complex nature of developmental changes in clearance mechanisms in infants during the first year of life. Hepatic and renal elimination mechanisms constitute the two principal clearance pathways of the developing infant. Drug metabolising enzyme activity is primarily responsible for the hepatic clearance of many drugs. In general, when compared with adult activity levels normalised to amount of hepatic microsomal protein, hepatic cytochrome P450-mediated metabolism and the phase II reactions of glucuronidation, glutathione conjugation and acetylation are deficient in the neonate, but sulfate conjugation is an efficient pathway at birth. Parturition triggers the dramatic development of drug metabolising enzymes, and each enzyme demonstrates an independent rate and pattern of maturation. Marked interindividual variability is associated with their developmental expression, making the ontogenesis of hepatic metabolism a highly variable process. By the first year of life, most enzymes have matured to adult activity levels. When compared with adult values, renal clearance mechanisms are compromised at birth. Dramatic increases in renal function occur in the ensuing postpartum period, and by 6 months of age glomerular filtration rate normalised to bodyweight has approached adult values. Maturation of renal tubular functions exhibits a more protracted time course of development, resulting in a glomerulotubular imbalance. This imbalance exists until adult renal tubule function values are approached by 1 year of age. The ontogeny of hepatic biliary and renal tubular transport processes and their impact on the elimination of drugs remain largely unknown. The summary of the current understanding of the ontogeny of individual pathways of hepatic and renal elimination presented in this review should serve as a basis for the continued accruement of age-specific information concerning the ontogeny of clearance mechanisms in infants. Such information can only help to improve the pharmacotherapeutic management of paediatric patients.
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Affiliation(s)
- Jane Alcorn
- Division of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky 40536-0082, USA
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19
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Brown DW, Picot PA, Naeini JG, Springett R, Delpy DT, Lee TY. Quantitative near infrared spectroscopy measurement of cerebral hemodynamics in newborn piglets. Pediatr Res 2002; 51:564-70. [PMID: 11978878 DOI: 10.1203/00006450-200205000-00004] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Severely premature infants are often at increased risk of cerebral hemorrhage and/or ischemic injury caused by immature autoregulatory control of blood flow to the brain. If blood flow is too high, the infant is at risk of hemorrhage, whereas too little blood flow can result in ischemic injury. The development of a noninvasive, bedside means of measuring cerebral hemodynamics would greatly facilitate both diagnosis and monitoring of afflicted individuals. It is to this end that we have developed a near infrared spectroscopy (NIRS) system that allows for quantitative, bedside measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The technique requires an i.v. injection of the near infrared chromophore indocyanine green. Six newborn piglets, median age of 18 h (range 6-54 h), median weight of 1.75 kg (range 1.5-2.1 kg), were studied. Measurements of CBF, CBV, and MTT were made at normocapnia, hypocapnia, and hypercapnia to test the technique over a range of hemodynamic conditions. The accuracy of our new approach has been determined by direct comparison with measurements made using a previously validated computed tomography technique. Paired t tests showed no significant difference between computed tomography and NIRS measurements of CBF, CBV, and MTT, and mean biases between the two methods were -2.05 mL x min(-1) x 100 g(-1), -0.18 mL x 100 g(-1), and 0.43 s, respectively. The precision of NIRS CBF, CBV, and MTT measurements, as determined by repeated-measures ANOVA, was 9.71%, 13.05%, and 7.57%, respectively.
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Affiliation(s)
- Derek W Brown
- Imaging Division, Lawson Health Research Institute, London, Ontario, Canada, N6A 4V2
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20
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Price GS, Frazier DL. Use of body surface area (BSA)-based dosages to calculate chemotherapeutic drug dose in dogs: I. Potential problems with current BSA formulae. J Vet Intern Med 1998; 12:267-71. [PMID: 9686386 DOI: 10.1111/j.1939-1676.1998.tb02121.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The dose of most cancer chemotherapeutic drugs administered to dogs is calculated on the basis of estimated body surface area (BSA); however results of some chemotherapy trials have revealed that this dosing method increases toxicosis in small dogs. The current formula used to estimate BSA in dogs may be inaccurate or the assumption that BSA correlates with chemotherapeutic drug exposure may be unfounded. Results presented in this review suggest that canine BSA estimates may be inaccurate because the values for the constant (K) and exponent (a) in the formulae (BSA = K.Wa) are incorrect or because a linear parameter such as body length is lacking from the formulae. Results that suggest the relationship between BSA and the physiologic/pharmacologic factors that influence drug exposure may not be closely correlated are also presented. Studies are warranted to determine whether there are dosing methods that normalize chemotherapeutic drug toxicity in dogs.
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Affiliation(s)
- G S Price
- Department of Companion Animal and Special Species Medicine, College of Veterinary Medicine, North Carolina State University, Raleigh 27606, USA.
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Hakkola J, Tanaka E, Pelkonen O. Developmental expression of cytochrome P450 enzymes in human liver. PHARMACOLOGY & TOXICOLOGY 1998; 82:209-17. [PMID: 9646325 DOI: 10.1111/j.1600-0773.1998.tb01427.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drug-metabolizing cytochrome P450 enzymes, the major phase I enzymes, are active in human liver already at very early stages of intrauterine development, although presumably at fairly low concentrations and in low numbers. During maturation, these enzymes go through various developmental programmes towards adulthood. The major increase both in abundance as well as in number of different enzymes takes place after birth, probably during the first year of life. Detailed information concerning these developmental changes is still limited. The major drug-metabolizing P450 enzymes appear to be primarily members of the CYP3A subfamily in all stages of development. The balance between different members of this subfamily, however, undergoes significant switches from the foetal predominant CYP3A7 to the major adult form CYP3A4. The ontogeny of the other cytochrome P450 enzymes is less well characterized, but the major switch-on appears to occur mainly after birth. Developmental expression of P450 enzymes is one of the key factors determining the pharmacokinetic status of developing individuals both pre- and postnatally.
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Affiliation(s)
- J Hakkola
- Department of Pharmacology and Toxicology, University of Oulu, Finland
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Chen WR, Adams RL, Carubelli R, Nordquist RE. Laser-photosensitizer assisted immunotherapy: a novel modality for cancer treatment. Cancer Lett 1997; 115:25-30. [PMID: 9097975 DOI: 10.1016/s0304-3835(97)04707-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Photosensitizer-enhanced laser treatment, where dyes are activated in situ by lasers of appropriate wavelengths, provides highly selective tissue destruction, both spatially and temporally, through photophysical reactions. Although laser-sensitizer treatment for cancer can achieve a controlled local tumor cell destruction on a large scale, total tumor eradication may not be accomplished because of the incomplete local tumor killing or the presence of tumor metastases, or both. The long-term control of cancer depends on the host immune surveillance and defense systems in which both cell-mediated and humoral responses are critical. In this study we report a novel minimally invasive cancer treatment combining the laser photophysical effects with the photobiological effects. Irradiation of a rat mammary tumor by an 805 nm diode laser, after an intratumor administration of a specific photosensitizer, indocyanine green in a glycated chitosan gel, caused immediate photothermal destruction of neoplastic cells. Concomitantly this treatment stimulated the immunological defense system against residual and metastatic tumor cells. Increases in survival rate and in the eradication of tumor burden, both primary and metastatic, were observed after this treatment. Furthermore, the resistance of successfully treated rats to tumor rechallenge demonstrated a long-lasting systemic effect of the treatment. These findings indicate that our treatment has triggered a specific humoral immune response in the tumor-bearing rats.
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Affiliation(s)
- W R Chen
- Physics Department, Oklahoma School of Science and Mathematics, Oklahoma City 73104, USA.
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23
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Affiliation(s)
- R J Jones
- Johns Hopkins Oncology Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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Adusumalli VE, Gilchrist JR, Wichmann JK, Kucharczyk N, Sofia RD. Pharmacokinetics of felbamate in pediatric and adult beagle dogs. Epilepsia 1992; 33:955-60. [PMID: 1396441 DOI: 10.1111/j.1528-1157.1992.tb02206.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The relative bioavailability and pharmacokinetics of felbamate (FBM) after a single oral dose and after 10 once-daily oral doses of 60 mg/kg were investigated in adult and pediatric dogs of both sexes. The pediatric and adult dogs were aged 4-6 weeks and 1-2 years, respectively. Analysis of variance (ANOVA) was performed on the bioavailability parameters among all groups and between the first and last doses. No sex-related differences in bioavailability and pharmacokinetic parameters were observed. The bioavailability of FBM in pediatric dogs was significantly less as compared with that in adult dogs. Rapid overall elimination of the drug in pediatric dogs appears to be responsible for the lower bioavailability. The bioavailability of FBM after the last dose was also significantly lower than after the first dose for both age groups. No major differences in the rate constant of FBM absorption (ka) and volume of distribution at steady state (VSS) were observed between the two age groups. As with other clinically useful antiepileptic drugs (AEDs), higher doses of FBM may be required in pediatric populations to achieve optimum drug levels, assuming that age-related changes in FBM disposition will also be confirmed in humans.
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Affiliation(s)
- V E Adusumalli
- Department of Biochemistry, Wallace Laboratories, Cranbury, New Jersey 08512
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