Determination of tacrolimus (FK 506) in whole blood using liquid chromatography and fluorescence detection

An improved validated ultra high pressure liquid chromatography method for separation of tacrolimus impurities and its tautomers

A selective, specific and sensitive ultra high pressure liquid chromatography (UHPLC) method was developed for determination of tacrolimus degradation products and tautomers in the preparation of pharmaceuticals. The chromatographic separation was performed on Waters ACQUITY UPLC system and BEH C₈ column using gradient elution of mobile phase A (90:10 v/v of 0.1% v/v triflouroacetic acid solution and Acetonitrile) and mobile phase B (90:10 v/v acetonitrile and water) at a flow rate of 0.6 mL min⁻¹. Ultraviolet detection was performed at 210 nm. Tacrolimus, tautomers and impurities were chromatographed with a total run time of 25 min. Calibration showed that the response of impurity was a linear function of concentration over the range 0.3-6 µg mL⁻¹ (r² ≥ 0.999) and the method was validated over this range for precision, intermediate precision, accuracy, linearity and specificity. For precision study, percentage relative standard deviation of each impurity was < 15% (n = 6). The method was found to be precise, accurate, linear and specific. The proposed method was successfully employed for estimation of tacrolimus impurities in pharmaceutical preparations.

Equilibrium studies of a fluorescent tacrolimus binding to surfactant protein A

Tacrolimus (FK506) is a hydrophobic immunosuppressive agent used in kidney, liver, and lung transplantation. The objective of this study was to characterize the binding of FK506 to surfactant protein A (SP-A), an abundant lipoprotein found in the alveolar fluid that functions as part of the innate immune system in the lung. We have synthesized a novel derivative of FK506 in which a dansyl moiety was covalently bound via cadaverine to the C22 position of the FK506 molecule (DNS-FK). Using the fluorescence and anisotropy properties of DNS-FK, we demonstrated that tacrolimus avidly binds to SP-A with an apparent equilibrium association constant (K(app)) of 10(7)M(-1) and a Gibbs binding free energy of -40 kJ mol(-1)K(-1). Derivatization of FK506 at the C22 position did not block FK506 binding to the cytosolic immunophilin FK506-binding protein (FK-BP) or human serum albumin (HSA), both used as controls of tacrolimus-binding proteins. K(app) for FK-BP/DNS-FK and HSA/DNS-FK complexes were 1.5 x 10(7) and 10(7)M(-1), respectively. The high sensitivity of this analytical technique makes it suitable for binding analysis of FK506 to proteins.

The EMIT 2000 tacrolimus assay: an application protocol for the Beckman Synchron LX20 PRO analyzer

OBJECTIVE

To develop and evaluate the performance of an application protocol for the EMIT 2000 tacrolimus (Tac) assay on the Beckman Synchron LX20 PRO Analyzer.

DESIGN AND METHODS

Precision, accuracy, linearity, and lower limit of quantitation were investigated. Specimens from 212 kidney, liver, heart/heart-lung, and islet cell transplant patients were analyzed and results were compared to those from the Abbott MEIA II assay. A separate population of 232 specimens was coanalyzed by the enzyme-multiplied immunoassay technique (EMIT) assay and liquid chromatography tandem mass spectrometry (LC-MS/MS).

RESULTS

Total imprecision was 13.7% and 6.0% at concentrations of 3.4 and 19.1 microg/L, respectively. Recoveries from assayed reference materials ranged from 103% to 109%. A quantitation range of 3.2-30.0 microg/L was validated. The EMIT assay on the LX20 PRO analyzer showed an average negative bias of 1% compared to the MEIA assay and an average positive bias of 17% compared to LC-MS/MS.

CONCLUSION

This application for the EMIT 2000 Tac assay on the Beckman Synchron LX20 PRO analyzer enhances the versatility of the immunoassay for routine therapeutic drug monitoring (TDM) of this immunosuppressant in the clinical setting.

Therapeutic monitoring of tacrolimus concentrations in blood: semi-automated extraction and liquid chromatography-electrospray ionization mass spectrometry

The authors describe a highly selective liquid chromatographic/mass spectrometric (LC/MS) method for measurement of the immunosuppressive drug tacrolimus. A protein-free supernatant of a patient's whole-blood sample (500 microL) is applied to an Empore styrene-divinylbenzene (SDB-XC) disk cartridge (Varian Sample Preparation Products; Harbor City, CA) to isolate tacrolimus and the internal standard, ascomycin. The entire extraction is automated on the Gilson ASPEC XL4 (Gilson; Middleton, WI). Separation takes place on an octyldecyl (C18) high-performance liquid chromatographic (HPLC) column maintained at 75 degrees C with a simple mobile phase of acetonitrile/water (90/10, v/v). An atmospheric pressure ionization (API)-electrospray ionization(ESI)-mass spectrometer (MS) is used for analysis. Detection is by selected ion monitoring (SIM) of the positively charged sodium adduct of tacrolimus and ascomycin, m/z 826.5 and 814.5, respectively. Collision-induced dissociation (CID) fragment ions of tacrolimus and ascomycin (m/z 616.4 and 604.4, respectively) are also monitored to enhance overall selectivity. Total run time is 1 minute per injection. A plot of chromatographic peak height ratio of m/z 826.5 to m/z 814.5 vs tacrolimus blood concentration is linear from the lowest limit of quantitation (0.3 microg/L) to at least 120.0 microg/L. Metabolites of tacrolimus and other immunosuppressive and commonly prescribed drugs do not interfere. Analytical recovery is 94% to 113% over a range of 4.4 to 41.0 microg/L. Between-run precision coefficients of variation (CV) are 3.6% to 4.2% over a range of 8.1 to 32.4 microg/L. Comparison data (n = 156) of the LC/MS method versus a commercial immunoassay (Abbott Tacrolimus IMx MEIA II) (Abbott; Chicago, IL) demonstrated that the tacrolimus concentration as measured by LC/MS = (0.912 x MEIA concentration) - 0.049; r2 = 0.968. This validated LC/MS method demonstrates significant advantages over conventional immunoassays and improves on the lower limit of detection, sensitivity, accuracy, and range of linearity. In the authors' laboratory, this method is approximately 60% less costly to perform than the most commonly implemented immunoassay. Together, the authors' daily clinical experience during 1 year and participation in a proficiency testing program has demonstrated that the method is robust and suitable for routine therapeutic monitoring of tacrolimus.

Comparative Clinical Pharmacokinetics of Tacrolimus in Paediatric and Adult Patients

Tacrolimus is a potent immunosuppressive agent used to prevent allograft rejection. The pharmacokinetics of tacrolimus have been studied in healthy volunteers and transplant recipients, mostly by using immunoassays to measure tacrolimus in plasma or blood. However, because of the cross-reactivity for certain tacrolimus metabolites of the antibodies used, these methods often lack specificity. This should be carefully taken into account when interpreting pharmacokinetic results for tacrolimus. In adult patients, tacrolimus is generally rapidly absorbed following oral administration (the time to reach maximum concentration is 1 to 2 hours), but in some patients absorption is slow or even delayed. Because of presystemic elimination, the oral bioavailability is low (around 20%) but may vary between 4 and 89%. Tacrolimus is highly bound to erythrocytes. Its binding to plasma proteins varies between 72 and 98% depending on the methodology used. Because of the extensive partitioning of tacrolimus into erythrocytes, its apparent volume of distribution (Vd) based on blood concentrations is much lower (1.0 to 1.5 L/kg) compared with values based on plasma concentrations (about 30 L/kg). Tacrolimus is metabolised by cytochrome P450 (CYP) 3A4 to at least 10 metabolites, some of which retain significant activity. Biliary excretion is the route of elimination of the tacrolimus metabolites. Systemic plasma clearance of tacrolimus is very high (0.6 to 5.4 L/h/kg), whereas blood clearance is much lower (0.03 to 0.09 L/h/kg). The terminal elimination half-life (t1/2beta) of tacrolimus is approximately 12 hours (with a range of 3.5 to 40.5 hours). Only limited information is available on the pharmacokinetics of tacrolimus in paediatric patients. The rate and extent of tacrolimus absorption after oral administration do not seem to be altered in paediatric patients. The Vd of tacrolimus based on blood concentrations in paediatric patients (2.6 L/kg) is approximately twice the adult value. Blood clearance of tacrolimus is also approximately twice as high in paediatric (0.14 L/h/kg) compared with adult (0.06 L/h/kg) patients. Consequently, t1/2beta does not appear modified in children, but oral doses need to be generally 2-fold higher than corresponding adult doses to reach similar tacrolimus blood concentrations. More pharmacokinetic studies in paediatric patients are, however, needed to rationalise the use of therapeutic drug monitoring for optimisation of tacrolimus therapy in this patient population.

Analytical Validation of the PRO-Trac II ELISA for the Determination of Tacrolimus (FK506) in Whole Blood

Background: The analytical validation of multiple lots of the PRO-TracTM II ELISA (DiaSorin) for the determination of tacrolimus in whole blood is described.

Methods: The analytical parameters assessed included analytical sensitivity, dilution linearity, functional sensitivity, values in samples containing no tacrolimus, intra- and interassay precision, supplementation and recovery, metabolite cross-reactivity, interference studies, and method comparisons HPLC-tandem mass spectrometry (HPLC/MS/MS) and the IMx® Tacrolimus II multiparticle enzyme immunoassay. Where appropriate, assessments were performed according to NCCLS guidelines.

Results: The mean analytical detection limit was &lt;0.25 μg/L for all lots, whereas the functional sensitivity was 1.0 μg/L. Excellent linear correlation (r = 0.985) was observed for dilution linearity. The intraassay imprecision was &lt;7%, and the total imprecision by ANOVA was &lt;10%. Recovery was 109% ± 11%. Metabolite cross-reactivity was consistent with previous reports for this antibody. No interference was observed for 35 tested drugs. Method comparison with HPLC/MS/MS showed no statistically significant differences. Samples exhibited stability through four freeze/thaw cycles and for 1 week at room temperature.

Conclusion: These data demonstrate that the PRO-Trac II ELISA is a robust, accurate, and precise tool for the assessment and management of tacrolimus blood concentrations in transplant patients.

Measurement of tacrolimus (FK506) and its metabolites: a review of assay development and application in therapeutic drug monitoring and pharmacokinetic studies

Tacrolimus (FK506, Prograf) is a macrolide immunosuppressant used for the prevention of organ rejection after transplantation. Tacrolimus demonstrates considerable interindividual variation in its pharmacokinetic profile. This has caused difficulty in defining the optimum regimen and has highlighted the need for therapeutic drug monitoring. Several assay methods for the measurements of tacrolimus in biological specimens have been developed. These assay methods were used for therapeutic drug monitoring and/or pharmacokinetic studies. Two commercially available immunoassays, based on the same monoclonal antibody to tacrolimus, have been used for therapeutic drug monitoring of tacrolimus in whole blood. For pharmacokinetic studies, the assay methods were used to measure tacrolimus and its metabolites in very low concentrations in selected biological matrixes to determine the metabolic and pharmacokinetic profiles of this drug.

Measurement of blood concentrations of FK506 (tacrolimus) and its metabolites in seven liver graft patients after the first dose by h.p.l.c.-MS and microparticle enzyme immunoassay (MEIA)

1. Blood and urine concentrations of the macrolide immunosuppressant FK506 and its metabolites were measured in seven orthotopic liver transplant patients after the first oral dose of FK506 (0.04 +/- 0.02 mg kg-1) used as primary immunosuppressant. A specific h.p.l.c.-MS assay was used, allowing the measurement of parent drug and eight metabolites. Results were compared with those obtained using a microparticle enzyme immunoassay (MEIA). 2. Blood drug concentrations were described by an open two compartment model with first-order absorption giving the following mean data: tmax: 1.9 (h), Cmax: 17.4 (microgram l-1), AUC: 328.1 (microgram l-1 h), t1/2,1: 0.74 (h). The terminal elimination half-life was estimated at about 26 h using the h.p.l.c.-MS assay. 3. The metabolites found in blood were demethyl-FK506 and demethyl-hydroxy-FK506, while in urine FK506 and eight of its metabolites were detected.