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Oduro-Kwateng E, Soliman ME. DON/DRP-104 as potent serine protease inhibitors implicated in SARS-CoV-2 infection: Comparative binding modes with human TMPRSS2 and novel therapeutic approach. J Cell Biochem 2024. [PMID: 38284235 DOI: 10.1002/jcb.30528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/31/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Abstract
Human transmembrane serine protease 2 (TMPRSS2) is an important member of the type 2 transmembrane serine protease (TTSP) family with significant therapeutic markings. The search for potent TMPRSS2 inhibitors against severe acute respiratory syndrome coronavirus 2 infection with favorable tissue specificity and off-site toxicity profiles remains limited. Therefore, probing the anti-TMPRSS2 potential of enhanced drug delivery systems, such as nanotechnology and prodrug systems, has become compelling. We report the first in silico study of TMPRSS2 against a prodrug, [isopropyl(S)-2-((S)-2-acetamido-3-(1H-indol-3-yl)-propanamido)-6-diazo-5-oxo-hexanoate] also known as DRP-104 synthesized from 6-Diazo-5-oxo-l-norleucine (DON). We performed comparative studies on DON and DRP-104 against a clinically potent TMPRSS2 inhibitor, nafamostat, and a standard serine protease inhibitor, 4-(2-Aminoethyl) benzenesulfonyl fluoride (AEBSF) against TMPRSS2 and found improved TMPRSS2 inhibition through synergistic binding of the S1/S1' subdomains. Both DON and DRP-104 had better thermodynamic profiles than AEBSF and nafamostat. DON was found to confer structural stability with strong positive correlated inter-residue motions, whereas DRP-104 was found to confer kinetic stability with restricted residue displacements and reduced loop flexibility. Interestingly, the Scavenger Receptor Cysteine-Rich (SRCR) domain of TMPRSS2 may be involved in its inhibition mechanics. Two previously unidentified loops, designated X (270-275) and Y (293-296) underwent minimal and major structural transitions, respectively. In addition, residues 273-277 consistently transitioned to a turn conformation in all ligated systems, whereas unique transitions were identified for other transitioning residue groups in each TMPRSS2-inhibitor complex. Intriguingly, while both DON and DRP-104 showed similar loop transition patterns, DRP-104 preserved loop structural integrity. As evident from our systematic comparative study using experimentally/clinically validated inhibitors, DRP-104 may serve as a potent and novel TMPRSS2 inhibitor and warrants further clinical investigation.
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Affiliation(s)
- Ernest Oduro-Kwateng
- School of Health Sciences, Molecular Bio-Computation and Drug Design Research Group, Westville Campus, University of KwaZulu Natal, Durban, South Africa
| | - Mahmoud E Soliman
- School of Health Sciences, Molecular Bio-Computation and Drug Design Research Group, Westville Campus, University of KwaZulu Natal, Durban, South Africa
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2
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Reus P, Guthmann H, Uhlig N, Agbaria M, Issmail L, Eberlein V, Nordling-David MM, Jbara-Agbaria D, Ciesek S, Bojkova D, Cinatl J, Burger-Kentischer A, Rupp S, Zaliani A, Grunwald T, Gribbon P, Kannt A, Golomb G. Drug repurposing for the treatment of COVID-19: Targeting nafamostat to the lungs by a liposomal delivery system. J Control Release 2023; 364:654-671. [PMID: 37939853 DOI: 10.1016/j.jconrel.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
Despite tremendous global efforts since the beginning of the COVID-19 pandemic, still only a limited number of prophylactic and therapeutic options are available. Although vaccination is the most effective measure in preventing morbidity and mortality, there is a need for safe and effective post-infection treatment medication. In this study, we explored a pipeline of 21 potential candidates, examined in the Calu-3 cell line for their antiviral efficacy, for drug repurposing. Ralimetinib and nafamostat, clinically used drugs, have emerged as attractive candidates. Due to the inherent limitations of the selected drugs, we formulated targeted liposomes suitable for both systemic and intranasal administration. Non-targeted and targeted nafamostat liposomes (LipNaf) decorated with an Apolipoprotein B peptide (ApoB-P) as a specific lung-targeting ligand were successfully developed. The developed liposomal formulations of nafamostat were found to possess favorable physicochemical properties including nano size (119-147 nm), long-term stability of the normally rapidly degrading compound in aqueous solution, negligible leakage from the liposomes upon storage, and a neutral surface charge with low polydispersity index (PDI). Both nafamostat and ralimetinib liposomes showed good cellular uptake and lack of cytotoxicity, and non-targeted LipNaf demonstrated enhanced accumulation in the lungs following intranasal (IN) administration in non-infected mice. LipNaf retained its anti-SARS-CoV 2 activity in Calu 3 cells with only a modest decrease, exhibiting complete inhibition at concentrations >100 nM. IN, but not intraperitoneal (IP) treatment with targeted LipNaf resulted in a trend to reduced viral load in the lungs of K18-hACE2 mice compared to targeted empty Lip. Nevertheless, upon removal of outlier data, a statistically significant 1.9-fold reduction in viral load was achieved. This observation further highlights the importance of a targeted delivery into the respiratory tract. In summary, we were able to demonstrate a proof-of-concept of drug repurposing by liposomal formulations with anti-SARS-CoV-2 activity. The biodistribution and bioactivity studies with LipNaf suggest an IN or inhalation route of administration for optimal therapeutic efficacy.
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Affiliation(s)
- Philipp Reus
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Discovery Research ScreeningPort, Schnackenburgallee 114, 22525 Hamburg, Germany; Goethe University Frankfurt, University Hospital, Institute for Medical Virology, Paul-Ehrlich-Straße 40, 60596 Frankfurt am Main, Germany
| | - Hadar Guthmann
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel; The Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Nadja Uhlig
- Fraunhofer Institute for Cell Therapy und Immunology IZI, Perlickstrasse 1, 04103 Leipzig, Germany
| | - Majd Agbaria
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Leila Issmail
- Fraunhofer Institute for Cell Therapy und Immunology IZI, Perlickstrasse 1, 04103 Leipzig, Germany
| | - Valentina Eberlein
- Fraunhofer Institute for Cell Therapy und Immunology IZI, Perlickstrasse 1, 04103 Leipzig, Germany
| | - Mirjam M Nordling-David
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Doaa Jbara-Agbaria
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Sandra Ciesek
- Goethe University Frankfurt, University Hospital, Institute for Medical Virology, Paul-Ehrlich-Straße 40, 60596 Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Denisa Bojkova
- Goethe University Frankfurt, University Hospital, Institute for Medical Virology, Paul-Ehrlich-Straße 40, 60596 Frankfurt am Main, Germany
| | - Jindrich Cinatl
- Goethe University Frankfurt, University Hospital, Institute for Medical Virology, Paul-Ehrlich-Straße 40, 60596 Frankfurt am Main, Germany
| | - Anke Burger-Kentischer
- Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Nobelstraße 12, 70569 Stuttgart, Germany
| | - Steffen Rupp
- Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Nobelstraße 12, 70569 Stuttgart, Germany
| | - Andrea Zaliani
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Discovery Research ScreeningPort, Schnackenburgallee 114, 22525 Hamburg, Germany
| | - Thomas Grunwald
- Fraunhofer Institute for Cell Therapy und Immunology IZI, Perlickstrasse 1, 04103 Leipzig, Germany
| | - Philip Gribbon
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Discovery Research ScreeningPort, Schnackenburgallee 114, 22525 Hamburg, Germany
| | - Aimo Kannt
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; Fraunhofer Innovation Center TheraNova, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; Institute for Clinical Pharmacology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
| | - Gershon Golomb
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel; The Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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3
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Seccia TM, Shagjaa T, Morpurgo M, Caroccia B, Sanga V, Faoro S, Venturini F, Iadicicco G, Lococo S, Mazzitelli M, Farnia F, Fioretto P, Kobayashi Y, Gregori D, Rossi GP. RAndomized Clinical Trial Of NAfamostat Mesylate, A Potent Transmembrane Protease Serine 2 (TMPRSS2) Inhibitor, in Patients with COVID-19 Pneumonia. J Clin Med 2023; 12:6618. [PMID: 37892756 PMCID: PMC10607860 DOI: 10.3390/jcm12206618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Even though SARS-CoV-2 was declared by WHO as constituting no longer a public health emergency, the development of effective treatments against SARS-CoV-2 infection remains a critical issue to prevent complications, particularly in fragile patients. The protease inhibitor nafamostat, currently used in Japan and Korea for pancreatitis, owing to its anticoagulant properties for disseminated intravascular coagulation (DIC), is appealing for the treatment of COVID-19 infection, because it potently inhibits the transmembrane protease serine 2 (TMPRSS2) that, after virus binding to ACE-2, allows virus entry into the cells and replication. Moreover, it could prevent the DIC and pulmonary embolism frequently associated with COVID-19 infection. The goal of the RAndomized Clinical Trial Of NAfamostat (RACONA) study, designed as a prospective randomized, double-blind placebo-controlled clinical trial, was to investigate the efficacy and safety of nafamostat mesylate (0.10 mg/kg/h iv for 7 days), on top of the optimal treatment, in COVID-19 hospitalized patients. We could screen 131 patients, but due to the predefined strict inclusion and exclusion criteria, only 15 could be randomized to group 1 (n = 7) or group 2 (n = 8). The results of an ad interim safety analysis showed similar overall trends for variables evaluating renal function, coagulation, and inflammation. No adverse events, including hyperkalemia, were found to be associated with nafamostat. Thus, the RACONA study showed a good safety profile of nafamostat, suggesting that it could be usefully used in COVID-19 hospitalized patients.
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Affiliation(s)
- Teresa Maria Seccia
- Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy; (T.M.S.); (T.S.); (V.S.)
| | - Tungalagtamir Shagjaa
- Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy; (T.M.S.); (T.S.); (V.S.)
| | - Margherita Morpurgo
- Department of Pharmaceutical & Pharmacological Sciences, University of Padua, 35131 Padua, Italy;
| | - Brasilina Caroccia
- Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy; (T.M.S.); (T.S.); (V.S.)
| | - Viola Sanga
- Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy; (T.M.S.); (T.S.); (V.S.)
| | - Sonia Faoro
- Pharmacy, University Hospital of Padua, 35126 Padua, Italy; (S.F.); (F.V.); (G.I.)
| | - Francesca Venturini
- Pharmacy, University Hospital of Padua, 35126 Padua, Italy; (S.F.); (F.V.); (G.I.)
| | - Girolama Iadicicco
- Pharmacy, University Hospital of Padua, 35126 Padua, Italy; (S.F.); (F.V.); (G.I.)
| | - Sara Lococo
- Pneumology, University Hospital of Padua, 35126 Padua, Italy;
| | - Maria Mazzitelli
- Infectious Diseases, University Hospital of Padua, 35126 Padua, Italy;
| | - Filippo Farnia
- Internal Medicine 3, University Hospital of Padua, 35128 Padua, Italy; (F.F.); (P.F.)
| | - Paola Fioretto
- Internal Medicine 3, University Hospital of Padua, 35128 Padua, Italy; (F.F.); (P.F.)
| | | | - Dario Gregori
- Biostatistics, Epidemiology and Public Health Unit, University of Padua, 35131 Padua, Italy;
| | - Gian Paolo Rossi
- Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy; (T.M.S.); (T.S.); (V.S.)
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Okugawa S, Ikeda M, Kashiwabara K, Moritoyo T, Kohsaka T, Shimizu T, Hagiya H, Hasegawa K, Otsuka F, Miwa A, Kisimoto N, Mizoguchi A, Imamura A, Ikeuchi K, Tsutsumi T, Jubishi D, Hashimoto H, Okamoto K, Harada S, Inoue JI, Seto Y, Moriya K. Antiviral effect and safety of nafamostat mesilate in patients with mild early-onset COVID-19: An exploratory multicentre randomized controlled clinical trial. Int J Antimicrob Agents 2023; 62:106922. [PMID: 37429450 DOI: 10.1016/j.ijantimicag.2023.106922] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/03/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES This study aimed to evaluate the antiviral effects and safety of nafamostat in early-onset patients with coronavirus disease 2019 (COVID-19). METHODS In this exploratory multicentre randomized controlled trial, patients were assigned to three groups within 5 days of symptom onset, with 10 participants in each group: nafamostat at either 0.2 mg/kg/h or 0.1 mg/kg/h or a standard-of-care group. The primary endpoint was area under the curve for decrease in SARS-CoV-2 viral load in nasopharyngeal samples from baseline to day 6. RESULTS Of the 30 randomized patients, 19 received nafamostat. Overall, 10 patients received low-dose nafamostat, 9 patients received high-dose nafamostat, and 10 received standard-of-care. The detected viruses were Omicron strains. The regression coefficient for area under the curve for decrease in viral load as the response variable and nafamostat dose per body weight as the explanatory variable showed a significant relationship of -40.1 (95% confidence interval, -74.1 to -6.2; P = 0.022). Serious adverse events were not observed in either group. Phlebitis occurred in ca. 50% of patients treated with nafamostat. CONCLUSIONS Nafamostat exerts virus load-reducing effects in patients with early-onset COVID-19.
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Affiliation(s)
- Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Mahoko Ikeda
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Kashiwabara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Moritoyo
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takao Kohsaka
- Department of Surgery, Horinouchi Hospital, Saitama, Japan
| | - Toshio Shimizu
- Department of Surgery, Horinouchi Hospital, Saitama, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ayumi Miwa
- Pharmaceutical Department, Takamatsu Municipal Hospital, Kagawa, Japan
| | - Nobuhito Kisimoto
- Department of Pulmonary Medicine, Takamatsu Municipal Hospital, Kagawa, Japan
| | - Ayako Mizoguchi
- Pharmaceutical Department, Moriya Keiyu Hospital, Ibaraki, Japan
| | - Akira Imamura
- Department of Internal medicine, Moriya Keiyu Hospital, Ibaraki, Japan
| | - Kazuhiko Ikeuchi
- Division of Infectious Diseases, Advanced Clinical Research Center, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Division of Infectious Diseases, Advanced Clinical Research Center, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Daisuke Jubishi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideki Hashimoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Sohei Harada
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun-Ichiro Inoue
- The University of Tokyo Pandemic Preparedness, Infection and Advanced Research Center (UTOPIA), Tokyo, Japan
| | - Yasuyuki Seto
- Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan.
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5
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Hernández-Mitre MP, Won H, Wallis SC, Parker SL, Roberts JA. Stability of nafamostat in intravenous infusion solutions, human whole blood and extracted plasma: implications for clinical effectiveness studies. Bioanalysis 2023; 15:673-681. [PMID: 37272603 DOI: 10.4155/bio-2023-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Aim: To describe the stability of nafamostat in infusion solutions, during blood sample collection and in extracted plasma samples in the autosampler. Methods: Nafamostat infusion solutions were stored at room temperature in the light for 24 h. For sample collection stability, fresh blood spiked with nafamostat was subjected to combinations of anticoagulants, added esterase inhibitor and temperature. Nafamostat was monitored in the extracted plasma samples in the autosampler. Results: Nafamostat was stable in infusion solutions. Nafamostat in whole blood was stable for 3 h before centrifugation when collected in sodium fluoride/potassium oxalate tubes (4°C). Nafamostat in extracted plasma samples degraded at 4.7 ± 0.7% per h. Conclusion: Viable samples can be obtained using blood collection tubes with sodium fluoride, chilling and processing promptly.
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Affiliation(s)
| | - Hayoung Won
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | - Steven C Wallis
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | - Suzanne L Parker
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
| | - Jason A Roberts
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, 4029, Australia
- Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, 4029, Australia
- Departments of Pharmacy & Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, 4029, Australia
- Division of Anaesthesiology Critical Care Emergency & Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, 30029, France
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Jeong JH, Lee WH, Min SC, Kim BK, Park OB, Chokkakula S, Ahn SJ, Oh S, Park JH, Jung JW, Jung JM, Kim EG, Song MS. Evaluation of the Antiviral Efficacy of Subcutaneous Nafamostat Formulated with Glycyrrhizic Acid against SARS-CoV-2 in a Murine Model. Int J Mol Sci 2023; 24:ijms24119579. [PMID: 37298530 DOI: 10.3390/ijms24119579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The ongoing COVID-19 pandemic highlights the urgent need for effective antiviral agents and vaccines. Drug repositioning, which involves modifying existing drugs, offers a promising approach for expediting the development of novel therapeutics. In this study, we developed a new drug, MDB-MDB-601a-NM, by modifying the existing drug nafamostat (NM) with the incorporation of glycyrrhizic acid (GA). We assessed the pharmacokinetic profiles of MDB-601a-NM and nafamostat in Sprague-Dawley rats, revealing rapid clearance of nafamostat and sustained drug concentration of MDB-601a-NM after subcutaneous administration. Single-dose toxicity studies showed potential toxicity and persistent swelling at the injection site with high-dose administration of MDB-601a-NM. Furthermore, we evaluated the efficacy of MDB-601a-NM in protecting against SARS-CoV-2 infection using the K18 hACE-2 transgenic mouse model. Mice treated with 60 mg/kg and 100 mg/kg of MDB-601a-NM exhibited improved protectivity in terms of weight loss and survival rates compared to the nafamostat-treated group. Histopathological analysis revealed dose-dependent improvements in histopathological changes and enhanced inhibitory efficacy in MDB-601a-NM-treated groups. Notably, no viral replication was detected in the brain tissue when mice were treated with 60 mg/kg and 100 mg/kg of MDB-601a-NM. Our developed MDB-601a-NM, a modified Nafamostat with glycyrrhizic acid, shows improved protectivity against SARS-CoV-2 infection. Its sustained drug concentration after subcutaneous administration and dose-dependent improvements makes it a promising therapeutic option.
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Affiliation(s)
- Ju Hwan Jeong
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - Woong Hee Lee
- MODNBIO Inc., Seoul 08378, Republic of Korea
- Institute of Biotechnology, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Seong Cheol Min
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - Beom Kyu Kim
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - On Bi Park
- Biomedical Engineering from the Department of Biotechnology, Graduate School of Advanced Fusion Technology, Cheongju University, Cheongju-si 28160, Republic of Korea
| | - Santosh Chokkakula
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - Seong Ju Ahn
- Biomedical Engineering from the Department of Biotechnology, Graduate School of Advanced Fusion Technology, Cheongju University, Cheongju-si 28160, Republic of Korea
| | - Sol Oh
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - Ji-Hyun Park
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
| | - Ji Won Jung
- Department of Medical Engineering, Catholic University of Daegu (DCU), Gyeongsan-si 38430, Republic of Korea
| | - Ji Min Jung
- Department of Medical IT, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea
| | - Eung-Gook Kim
- Department of Biochemistry, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju 28644, Republic of Korea
| | - Min-Suk Song
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju-si 28644, Republic of Korea
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7
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Ikeda M, Okugawa S, Kashiwabara K, Moritoyo T, Kanno Y, Jubishi D, Hashimoto H, Okamoto K, Tsushima K, Uchida Y, Mitsumura T, Igari H, Tsutsumi T, Araoka H, Yatera K, Yamamoto Y, Nakamura Y, Otani A, Yamashita M, Wakimoto Y, Shinohara T, Adachi-Katayama M, Oyabu T, Kanematsu A, Harada S, Takeshita Y, Nakano Y, Miyazaki Y, Sakao S, Saito M, Ogura S, Yamasaki K, Kawasuji H, Hataji O, Inoue JI, Seto Y, Moriya K. Multicenter, single-blind, randomized controlled study of the efficacy and safety of favipiravir and nafamostat mesilate in patients with COVID-19 pneumonia. Int J Infect Dis 2023; 128:355-363. [PMID: 36610659 PMCID: PMC9810545 DOI: 10.1016/j.ijid.2022.12.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of nafamostat combined with favipiravir for the treatment of COVID-19. METHODS We conducted a multicenter, randomized, single-blind, placebo-controlled, parallel assignment study in hospitalized patients with mild-to-moderate COVID-19 pneumonia. Patients were randomly assigned to receive favipiravir alone (n = 24) or nafamostat with favipiravir (n = 21). The outcomes included changes in the World Health Organization clinical progression scale score, time to improvement in body temperature, and improvement in oxygen saturation (SpO2). RESULTS There was no significant difference in the changes in the clinical progression scale between nafamostat with favipiravir and favipiravir alone groups (median, -0.444 vs -0.150, respectively; least-squares mean difference, -0.294; P = 0.364). The time to improvement in body temperature was significantly shorter in the combination group (5.0 days; 95% confidence interval, 4.0-7.0) than in the favipiravir group (9.0 days; 95% confidence interval, 7.0-18.0; P =0.009). The changes in SpO2 were greater in the combination group than in the favipiravir group (0.526% vs -1.304%, respectively; least-squares mean difference, 1.831; P = 0.022). No serious adverse events or deaths were reported, but phlebitis occurred in 57.1% of the patients in the combination group. CONCLUSION Although our study showed no differences in clinical progression, earlier defervescence, and recovery of SpO2 were observed in the combination group.
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Affiliation(s)
- Mahoko Ikeda
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Kosuke Kashiwabara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takashi Moritoyo
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiaki Kanno
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Jubishi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideki Hashimoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Yasuki Uchida
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Hidetoshi Igari
- Department of Infection Control, Chiba University Hospital, Chiba, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Division of Infectious Diseases, Advanced Clinical Research Center, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, Hospital of the University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Hospital, Toyama, Japan
| | - Yuki Nakamura
- Respiratory Center, Matsusaka Municipal Hospital, Mie, Japan
| | - Amato Otani
- Research Platform Office, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Marie Yamashita
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuji Wakimoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Takayuki Shinohara
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Maho Adachi-Katayama
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Tatsunori Oyabu
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Aoi Kanematsu
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Sohei Harada
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuichiro Takeshita
- Department of Pulmonary Medicine, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Seiichiro Sakao
- Department of Infection Control, Chiba University Hospital, Chiba, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Sho Ogura
- Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, Hospital of the University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hitoshi Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Hospital, Toyama, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Mie, Japan
| | - Jun-Ichiro Inoue
- Research Platform Office, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Stomach and Esophageal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan.
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8
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Jeong HC, Chae YJ, Shin KH. Predicting the systemic exposure and lung concentration of nafamostat using physiologically-based pharmacokinetic modeling. Transl Clin Pharmacol 2022; 30:201-211. [PMID: 36632076 PMCID: PMC9810492 DOI: 10.12793/tcp.2022.30.e20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Nafamostat has been actively studied for its neuroprotective activity and effect on various indications, such as coronavirus disease 2019 (COVID-19). Nafamostat has low water solubility at a specific pH and is rapidly metabolized in the blood. Therefore, it is administered only intravenously, and its distribution is not well known. The main purposes of this study are to predict and evaluate the pharmacokinetic (PK) profiles of nafamostat in a virtual healthy population under various dosing regimens. The most important parameters were assessed using a physiologically based pharmacokinetic (PBPK) approach and global sensitivity analysis with the Sobol sensitivity analysis. A PBPK model was constructed using the SimCYP® simulator. Data regarding the in vitro metabolism and clinical studies were extracted from the literature to assess the predicted results. The model was verified using the arithmetic mean maximum concentration (Cmax), the area under the curve from 0 to the last time point (AUC0-t), and AUC from 0 to infinity (AUC0-∞) ratio (predicted/observed), which were included in the 2-fold range. The simulation results suggested that the 2 dosing regimens for the treatment of COVID-19 used in the case reports could maintain the proposed effective concentration for inhibiting severe acute respiratory syndrome coronavirus 2 entry into the plasma and lung tissue. Global sensitivity analysis indicated that hematocrit, plasma half-life, and microsomal protein levels significantly influenced the systematic exposure prediction of nafamostat. Therefore, the PBPK modeling approach is valuable in predicting the PK profile and designing an appropriate dosage regimen.
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Affiliation(s)
- Hyeon-Cheol Jeong
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea
| | - Yoon-Jee Chae
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Woosuk University, Wanju 55338, Korea
| | - Kwang-Hee Shin
- Research Institute of Pharmaceutical Sciences, College of Pharmacy, Kyungpook National University, Daegu 41566, Korea
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9
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Decraecker L, Boeckxstaens G, Denadai-Souza A. Inhibition of Serine Proteases as a Novel Therapeutic Strategy for Abdominal Pain in IBS. Front Physiol 2022; 13:880422. [PMID: 35665224 PMCID: PMC9161638 DOI: 10.3389/fphys.2022.880422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
Serine proteases are heavily present in the gastrointestinal tract where they are essential in numerous physiological processes. An imbalance in the proteolytic activity is a central mechanism underlying abdominal pain in irritable bowel syndrome (IBS). Therefore, protease inhibitors are emerging as a promising therapeutic tool to manage abdominal pain in this functional gastrointestinal disorder. With this review, we provide an up-to-date overview of the implications of serine proteases in the development of abdominal pain in IBS, along with a critical assessment of the current developments and prospects of protease inhibitors as a therapeutic tool. In particular, we highlight the current knowledge gap concerning the identity of dysregulated serine proteases that are released by the rectal mucosa of IBS patients. Finally, we suggest a workflow with state-of-the-art techniques that will help address the knowledge gap, guiding future research towards the development of more effective and selective protease inhibitors to manage abdominal pain in IBS.
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10
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Oh HS, Kim T, Gu DH, Lee TS, Kim TH, Shin S, Shin BS. Pharmacokinetics of Nafamostat, a Potent Serine Protease Inhibitor, by a Novel LC-MS/MS Analysis. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27061881. [PMID: 35335247 PMCID: PMC8955020 DOI: 10.3390/molecules27061881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
Abstract
Nafamostat, a synthetic serine protease inhibitor, has been used for the treatment of inflammatory diseases such as pancreatitis. Recently, an increasing number of studies have shown the promising antiviral effects of nafamostat for the treatment of coronavirus disease-19 (COVID-19). This study aimed to develop a novel liquid chromatography–tandem mass spectrometry (LC-MS/MS) analysis and to characterize the pharmacokinetics of nafamostat in rats. Nafamostat in the rat plasma was extracted by solid phase extraction, and 13C6-nafamostat was used as an internal standard. The quantification limit of nafamostat in the rat plasma was 0.5 ng/mL. The LC-MS/MS method was fully validated and applied to characterize the pharmacokinetics of nafamostat in rats. Following intravenous injection (2 mg/kg), nafamostat in the plasma showed a multiexponential decline with an average elimination half-life (t1/2) of 1.39 h. Following oral administration of nafamostat solutions (20 mg/kg) in 10% dimethyl sulfoxide (DMSO) and in 10% DMSO with 10% Tween 80, nafamostat was rapidly absorbed, and the average oral bioavailability was 0.95% and 1.59%, respectively. The LC-MS/MS method and the pharmacokinetic information of nafamostat could be helpful for the further preclinical and clinical studies of nafamostat.
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Affiliation(s)
- Hyeon Seok Oh
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.S.O.); (T.K.); (D.-H.G.); (T.S.L.)
| | - Taehyung Kim
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.S.O.); (T.K.); (D.-H.G.); (T.S.L.)
| | - Dong-Hyeon Gu
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.S.O.); (T.K.); (D.-H.G.); (T.S.L.)
| | - Tae Suk Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.S.O.); (T.K.); (D.-H.G.); (T.S.L.)
| | - Tae Hwan Kim
- College of Pharmacy, Daegu Catholic University, Gyeongsan 38430, Korea;
| | - Soyoung Shin
- College of Pharmacy, Wonkwang University, Iksan 54538, Korea;
| | - Beom Soo Shin
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (H.S.O.); (T.K.); (D.-H.G.); (T.S.L.)
- Correspondence: ; Tel.: +82-31-290-7705
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11
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Quinn TM, Gaughan EE, Bruce A, Antonelli J, O'Connor R, Li F, McNamara S, Koch O, MacKintosh C, Dockrell D, Walsh T, Blyth KG, Church C, Schwarze J, Boz C, Valanciute A, Burgess M, Emanuel P, Mills B, Rinaldi G, Hardisty G, Mills R, Findlay EG, Jabbal S, Duncan A, Plant S, Marshall ADL, Young I, Russell K, Scholefield E, Nimmo AF, Nazarov IB, Churchill GC, McCullagh JSO, Ebrahimi KH, Ferrett C, Templeton K, Rannard S, Owen A, Moore A, Finlayson K, Shankar-Hari M, Norrie J, Parker RA, Akram AR, Anthony DC, Dear JW, Hirani N, Dhaliwal K. Randomised controlled trial of intravenous nafamostat mesylate in COVID pneumonitis: Phase 1b/2a experimental study to investigate safety, Pharmacokinetics and Pharmacodynamics. EBioMedicine 2022; 76:103856. [PMID: 35152152 PMCID: PMC8831100 DOI: 10.1016/j.ebiom.2022.103856] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Many repurposed drugs have progressed rapidly to Phase 2 and 3 trials in COVID19 without characterisation of Pharmacokinetics /Pharmacodynamics including safety data. One such drug is nafamostat mesylate. METHODS We present the findings of a phase Ib/IIa open label, platform randomised controlled trial of intravenous nafamostat in hospitalised patients with confirmed COVID-19 pneumonitis. Patients were assigned randomly to standard of care (SoC), nafamostat or an alternative therapy. Nafamostat was administered as an intravenous infusion at a dose of 0.2 mg/kg/h for a maximum of seven days. The analysis population included those who received any dose of the trial drug and all patients randomised to SoC. The primary outcomes of our trial were the safety and tolerability of intravenous nafamostat as an add on therapy for patients hospitalised with COVID-19 pneumonitis. FINDINGS Data is reported from 42 patients, 21 of which were randomly assigned to receive intravenous nafamostat. 86% of nafamostat-treated patients experienced at least one AE compared to 57% of the SoC group. The nafamostat group were significantly more likely to experience at least one AE (posterior mean odds ratio 5.17, 95% credible interval (CI) 1.10 - 26.05) and developed significantly higher plasma creatinine levels (posterior mean difference 10.57 micromol/L, 95% CI 2.43-18.92). An average longer hospital stay was observed in nafamostat patients, alongside a lower rate of oxygen free days (rate ratio 0.55-95% CI 0.31-0.99, respectively). There were no other statistically significant differences in endpoints between nafamostat and SoC. PK data demonstrated that intravenous nafamostat was rapidly broken down to inactive metabolites. We observed no significant anticoagulant effects in thromboelastometry. INTERPRETATION In hospitalised patients with COVID-19, we did not observe evidence of anti-inflammatory, anticoagulant or antiviral activity with intravenous nafamostat, and there were additional adverse events. FUNDING DEFINE was funded by LifeArc (an independent medical research charity) under the STOPCOVID award to the University of Edinburgh. We also thank the Oxford University COVID-19 Research Response Fund (BRD00230).
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Affiliation(s)
- Tom M Quinn
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Erin E Gaughan
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Annya Bruce
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Jean Antonelli
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Richard O'Connor
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Feng Li
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sarah McNamara
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Oliver Koch
- Regional Infectious Disease Unit, NHS Lothian, UK
| | | | - David Dockrell
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Regional Infectious Disease Unit, NHS Lothian, UK
| | - Timothy Walsh
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, UK
| | - Colin Church
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Jürgen Schwarze
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Cecilia Boz
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Asta Valanciute
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Matthew Burgess
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Philip Emanuel
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Bethany Mills
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Giulia Rinaldi
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Gareth Hardisty
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Ross Mills
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Emily Gwyer Findlay
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sunny Jabbal
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | | | - Sinéad Plant
- Regional Infectious Disease Unit, NHS Lothian, UK
| | - Adam D L Marshall
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Irene Young
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Kay Russell
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Emma Scholefield
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Alastair F Nimmo
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Islom B Nazarov
- Latus Therapeutics, Oxford, UK; Department of Pharmacology, University of Oxford, Oxford, UK
| | | | | | | | - Colin Ferrett
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Templeton
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Steve Rannard
- Centre of Excellence for Long-acting Therapeutics, Materials Innovation Factory and Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Andrew Owen
- Centre of Excellence for Long-acting Therapeutics, Materials Innovation Factory and Department of Pharmacology and Therapeutics, University of Liverpool, UK
| | - Anne Moore
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Keith Finlayson
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Manu Shankar-Hari
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK
| | - John Norrie
- Centre for Cardiovascular Science, Queen's Medical Research Institute, Bioquarter, University of Edinburgh, Edinburgh, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit (ECTU), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | | | - James W Dear
- Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh,; Centre for Cardiovascular Science, Queen's Medical Research Institute, Bioquarter, University of Edinburgh, Edinburgh, UK
| | - Nik Hirani
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh
| | - Kevin Dhaliwal
- Centre for Inflammation Research, Queen's Medical Research Institute, BioQuarter, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, BioQuarter, Little France, Edinburgh,.
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12
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Cho YS, Shin JG. Physiologically-based pharmacokinetic modeling of nafamostat to support dose selection for treatment of pediatric patients with COVID-19. Transl Clin Pharmacol 2022; 30:24-36. [PMID: 35419314 PMCID: PMC8979760 DOI: 10.12793/tcp.2022.30.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
Pediatric patients with coronavirus disease 2019 (COVID-19) are increasing, and severe cases such as multisystem inflammatory syndrome are being reported. Nafamostat, a repurposing drug, is currently being explored for the treatment of COVID-19 in adults. However, the data supporting its exposure in pediatrics remains scarce. Physiologically-based pharmacokinetic (PBPK) modeling enables the prediction of drug exposure in pediatrics based on ontogeny of metabolic enzymes and age dependent anatomical and physiological changes. The study aimed to establish a PBPK model of nafamostat in adults, then scale the adult PBPK model to children for predicting pediatric exposures of nafamostat and an optimal weight-based nafamostat dose in pediatric population. The developed model adequately described adult exposure data in healthy volunteers following i.v. administration with three doses (10, 20, and 40 mg). Scaling adult PBPK models to five pediatric groups predicted that as age advances from neonate to adult, the exposure of nafamostat slightly increased from neonate to infant, steadily decreased from infant to child, and then increased from child to adult after the administration of 0.2 mg/kg/h for 14 days, a dosing regimen being conducted in a clinical trial for COVID-19. Based on the fold change of predicted area under the curve for the respective pediatric group over those of adults, weight-based dosages for each pediatric group may be suggested. The novel PBPK model described in this study may be useful to investigate nafamostat pharmacokinetics in a pediatric subgroup further.
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Affiliation(s)
- Yong-Soon Cho
- Center for Personalized Precision Medicine of Tuberculosis (cPMTb), Inje University College of Medicine, Busan 47392, Korea
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
| | - Jae-Gook Shin
- Center for Personalized Precision Medicine of Tuberculosis (cPMTb), Inje University College of Medicine, Busan 47392, Korea
- Department of Pharmacology and Clinical Pharmacology, PharmacoGenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
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13
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Kang JH, Kim YJ, Yang MS, Shin DH, Kim DW, Park IY, Park CW. Co-Spray Dried Nafamostat Mesylate with Lecithin and Mannitol as Respirable Microparticles for Targeted Pulmonary Delivery: Pharmacokinetics and Lung Distribution in Rats. Pharmaceutics 2021; 13:1519. [PMID: 34575594 PMCID: PMC8468663 DOI: 10.3390/pharmaceutics13091519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 01/28/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by a new strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spreading rapidly worldwide. Nafamostat mesylate (NFM) suppresses transmembrane serine protease 2 and SARS-CoV-2 S protein-mediated fusion. In this study, pharmacokinetics and lung distribution of NFM, administered via intravenous and intratracheal routes, were determined using high performance liquid chromatography analysis of blood plasma, lung lumen using bronchoalveolar lavage fluid, and lung tissue. Intratracheal administration had higher drug delivery and longer residual time in the lung lumen and tissue, which are the main sites of action, than intravenous administration. We confirmed the effect of lecithin as a stabilizer through an ex vivo stability test. Lecithin acts as an inhibitor of carboxylesterase and delays NFM decomposition. We prepared inhalable microparticles with NFM, lecithin, and mannitol via the co-spray method. The formulation prepared using an NFM:lecithin:mannitol ratio of 1:1:100 had a small particle size and excellent aerodynamic performance. Spray dried microparticles containing NFM, lecithin, and mannitol (1:1:100) had the longest residual time in the lung tissue. In conclusion, NFM-inhalable microparticles were prepared and confirmed to be delivered into the respiratory tract, such as lung lumen and lung tissue, through in vitro and in vivo evaluations.
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Affiliation(s)
- Ji-Hyun Kang
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Korea; (J.-H.K.); (Y.-J.K.); (M.-S.Y.); (D.H.S.)
| | - Young-Jin Kim
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Korea; (J.-H.K.); (Y.-J.K.); (M.-S.Y.); (D.H.S.)
| | - Min-Seok Yang
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Korea; (J.-H.K.); (Y.-J.K.); (M.-S.Y.); (D.H.S.)
| | - Dae Hwan Shin
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Korea; (J.-H.K.); (Y.-J.K.); (M.-S.Y.); (D.H.S.)
| | - Dong-Wook Kim
- Department of Pharmaceutical Engineering, Cheongju University, Cheongju 28503, Korea;
| | - Il Yeong Park
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Korea; (J.-H.K.); (Y.-J.K.); (M.-S.Y.); (D.H.S.)
| | - Chun-Woong Park
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Korea; (J.-H.K.); (Y.-J.K.); (M.-S.Y.); (D.H.S.)
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14
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Zeitlinger M, Koch BCP, Bruggemann R, De Cock P, Felton T, Hites M, Le J, Luque S, MacGowan AP, Marriott DJE, Muller AE, Nadrah K, Paterson DL, Standing JF, Telles JP, Wölfl-Duchek M, Thy M, Roberts JA. Pharmacokinetics/Pharmacodynamics of Antiviral Agents Used to Treat SARS-CoV-2 and Their Potential Interaction with Drugs and Other Supportive Measures: A Comprehensive Review by the PK/PD of Anti-Infectives Study Group of the European Society of Antimicrobial Agents. Clin Pharmacokinet 2020; 59:1195-1216. [PMID: 32725382 PMCID: PMC7385074 DOI: 10.1007/s40262-020-00924-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is an urgent need to identify optimal antiviral therapies for COVID-19 caused by SARS-CoV-2. We have conducted a rapid and comprehensive review of relevant pharmacological evidence, focusing on (1) the pharmacokinetics (PK) of potential antiviral therapies; (2) coronavirus-specific pharmacodynamics (PD); (3) PK and PD interactions between proposed combination therapies; (4) pharmacology of major supportive therapies; and (5) anticipated drug-drug interactions (DDIs). We found promising in vitro evidence for remdesivir, (hydroxy)chloroquine and favipiravir against SARS-CoV-2; potential clinical benefit in SARS-CoV-2 with remdesivir, the combination of lopinavir/ritonavir (LPV/r) plus ribavirin; and strong evidence for LPV/r plus ribavirin against Middle East Respiratory Syndrome (MERS) for post-exposure prophylaxis in healthcare workers. Despite these emerging data, robust controlled clinical trials assessing patient-centred outcomes remain imperative and clinical data have already reduced expectations with regard to some drugs. Any therapy should be used with caution in the light of potential drug interactions and the uncertainty of optimal doses for treating mild versus serious infections.
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Affiliation(s)
- Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | | | | | - Pieter De Cock
- Department of Pharmacy 2, Heymans Institute of Pharmacology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Timothy Felton
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maya Hites
- Clinic of Infectious Diseases, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, CA, USA
| | - Sonia Luque
- Pharmacy Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar D'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Alasdair P MacGowan
- Bristol Centre for Antimicrobial Research and Evaluation, Infection Sciences, Severn Pathology Partnership, North Bristol NHS Trust, Southmead Hospital, Westbury-On-Trym, Bristol, UK
| | - Deborah J E Marriott
- St. Vincent's Hospital, Darlinghurst, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Anouk E Muller
- HaaglandenMC, The Hague and ErasmusMC, Rotterdam, The Netherlands
| | - Kristina Nadrah
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Joseph F Standing
- Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Pharmacy, Great Ormond Street Hospital for Children, London, UK
| | - João P Telles
- Department of Infectious Diseases, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Michael Wölfl-Duchek
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Michael Thy
- Infectious Diseases Department and Intensive Care Unit, Hospital Bichat, Paris, France
- EA7323, Evaluation of Perinatal and Paediatric Therapeutics and Pharmacology, University Paris Descartes, Paris, France
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Centre for Translational Anti-Infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
- Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France.
- The University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia.
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15
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Zhang Y, An L, Zhang L, Wang R, Tian Y, Zhang Z. Identification of impurities in nafamostat mesylate using HPLC-IT-TOF/MS: A series of double-charged ions. J Pharm Anal 2020; 10:346-350. [PMID: 32923008 PMCID: PMC7474109 DOI: 10.1016/j.jpha.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/29/2022] Open
Abstract
Nafamostat mesylate is a serine protease inhibitor used in the treatment of acute pancreatitis. The impurities in nafamostat mesylate, the active pharmaceutical ingredient (API), were profiled via high performance liquid chromatography tandem ion trap coupled with time-of-flight mass spectrometer (HPLC-IT-TOF/MS). The chromatography was performed on an ACE-3 C18 column (200 mm × 4.6 mm, 3 μm) using methanol and 0.1% formic acid in purified water as mobile phase at a flow rate of 1.0 mL/min. The ions were detected by IT-TOF/MS with a full-scan mass analysis from m/z 100 to 800. In total, eleven impurities were detected in nafamostat mesylate API. The impurity profile was estimated based on the HPLC-IT-TOF/MS data, including accurate masses, MSn fingerprints of fragmentation pathways and a series of double-charged ions. Finally, seven impurities were identified and reported for the first time. The results will provide technical support for the quality control and clinical safety of nafamostat mesylate.
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Affiliation(s)
- Yuxin Zhang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, PR China
| | - Lufan An
- Jiangsu D&R Pharmaceutical Corporation, Taizhou, 225312, PR China
| | - Lin Zhang
- Department of Pharmacy, General Hospital Tianjin Medical University, Tianjin, 300052, PR China
| | - Rulin Wang
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing, 210009, PR China
| | - Yuan Tian
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing, 210009, PR China
| | - Zunjian Zhang
- Key Laboratory of Drug Quality Control and Pharmacovigilance (Ministry of Education), China Pharmaceutical University, Nanjing, 210009, PR China
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16
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Li CC, Wang XJ, Wang HCR. Repurposing host-based therapeutics to control coronavirus and influenza virus. Drug Discov Today 2019; 24:726-736. [PMID: 30711575 PMCID: PMC7108273 DOI: 10.1016/j.drudis.2019.01.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/11/2019] [Accepted: 01/28/2019] [Indexed: 12/11/2022]
Abstract
Drug repositioning is a cost- and time-efficient approach for new indications. Targeting host machineries, used by viruses, could develop broad-spectrum antivirals. Repurposing existing drugs could efficiently identify antiviral agents.
The development of highly effective antiviral agents has been a major objective in virology and pharmaceutics. Drug repositioning has emerged as a cost-effective and time-efficient alternative approach to traditional drug discovery and development. This new shift focuses on the repurposing of clinically approved drugs and promising preclinical drug candidates for the therapeutic development of host-based antiviral agents to control diseases caused by coronavirus and influenza virus. Host-based antiviral agents target host cellular machineries essential for viral infections or innate immune responses to interfere with viral pathogenesis. This review discusses current knowledge, prospective applications and challenges in the repurposing of clinically approved and preclinically studied drugs for newly indicated antiviral therapeutics.
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Affiliation(s)
- Cui-Cui Li
- Key Laboratory of Animal Epidemiology of the Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Xiao-Jia Wang
- Key Laboratory of Animal Epidemiology of the Ministry of Agriculture, College of Veterinary Medicine, China Agricultural University, Beijing, China.
| | - Hwa-Chain Robert Wang
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, USA.
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17
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Factors affecting the stability of drugs and drug metabolites in biological matrices. Bioanalysis 2011; 1:205-20. [PMID: 21083197 DOI: 10.4155/bio.09.20] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Evaluation of the stability of drugs and drug metabolites in a biological matrix is a critical element to bioanalytical method validation. It is critical to understand the most common factors that affect the stability of such analytes in order to properly develop methods for their detection and measurement. The degradation of drugs and drug metabolites in samples can occur through either reversible or irreversible processes. Common factors that affect this stability include temperature, light, pH, oxidation and enzymatic degradation. Special considerations are also required when dealing with chiral molecules, deuterated internal standards and large biomolecules. Relevant examples of these degradation effects and approaches for dealing with them are presented is this review as taken from the fields of pharmaceutical testing, clinical research and forensic analysis. It is demonstrated through these examples how an understanding of the chemical and physical factors that affect sample stability can be used to avoid stability problems and to create robust and accurate methods for the analysis of drugs and related compounds.
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18
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Li W, Zhang J, Tse FLS. Strategies in quantitative LC-MS/MS analysis of unstable small molecules in biological matrices. Biomed Chromatogr 2010; 25:258-77. [DOI: 10.1002/bmc.1572] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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19
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Critical topics in ensuring data quality in bioanalytical LC–MS method development. Bioanalysis 2010; 2:1051-72. [DOI: 10.4155/bio.10.60] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The use of LC–MS for bioanalysis of pharmaceuticals is entering its third decade and may be considered to be a mature technology. In many respects this is true, considering the advances made in such areas as instrument performance, electronics, software and automation of use. However, there remain instrumental and noninstrumental areas that require significant attention to ensure data quality. Increasing regulatory focus on analytical method performance and unaddressed method issues require the bioanalyst to understand those areas that most greatly impact data quality. This review will focus on instrumental and noninstrumental areas that can influence data quality, including reference standard and internal standard quality and physicochemical properties, matrix effects, stability in matrix, sample preparation, LC and MS.
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20
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Quantification of polar drugs in human plasma with liquid chromatography–tandem mass spectrometry. Bioanalysis 2009; 1:187-203. [DOI: 10.4155/bio.09.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Liquid chromatography–tandem mass spectrometry (LC–MS/MS) has played an important role in quantitative bioanalytical assays. This review summarizes the recent progress on quantification of polar drugs in plasma with LC–MS/MS. Various types of polar analytes were extracted using protein precipitation or solid-phase extraction and precolumn derivatization was utilized in some cases. The analytes were then separated using different types of chromatographic method, which included reversed-phase chromatography, aqueous normal-phase chromatography, hydrophilic interaction liquid chromatography and ion-pairing chromatography. Stationary phases of mixed mode and porous graphitic carbon materials are gaining acceptance in bioanalytical applications. These technologies can be valuable supplements in the quantification of polar drugs in human plasma with LC–MS/MS. Matrix effects have also been discussed in this review.
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21
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Cao YG, Chen YC, Hao K, Zhang M, Liu XQ. An in Vivo Approach for Globally Estimating the Drug Flow between Blood and Tissue for Nafamostat Mesilate: the Main Hydrolysis Site Determination in Human. Biol Pharm Bull 2008; 31:1985-9. [DOI: 10.1248/bpb.31.1985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yan-Guang Cao
- Key Laboratory of Drug Metabolism & Pharmacokinetics, China Pharmaceutical University
| | - Yuan-Cheng Chen
- Key Laboratory of Drug Metabolism & Pharmacokinetics, China Pharmaceutical University
| | - Kun Hao
- Key Laboratory of Drug Metabolism & Pharmacokinetics, China Pharmaceutical University
| | - Ming Zhang
- Key Laboratory of Drug Metabolism & Pharmacokinetics, China Pharmaceutical University
| | - Xiao-Quan Liu
- Key Laboratory of Drug Metabolism & Pharmacokinetics, China Pharmaceutical University
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