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Hirano R, Yokokawa A, Furihata T, Shibasaki H. Dried blood spots analysis of 6β-hydroxycortisol and cortisol using liquid chromatography/tandem mass spectrometry for calculating 6β-hydroxycortisol to cortisol ratio. JOURNAL OF MASS SPECTROMETRY : JMS 2021; 56:e4790. [PMID: 34881490 DOI: 10.1002/jms.4790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
Dried blood spot (DBS) sampling is a minimally invasive method used to collect blood samples of any population for personalized medicine. We aimed to develop a sensitive and reliable analytical method for measuring 6β-hydroxycortisol (6β-OHF) and cortisol concentrations in DBS by liquid chromatography/tandem mass spectrometry so as to utilize DBS as a less invasive blood sampling method for calculating the ratio of 6β-OHF/cortisol. The lower limits of quantification obtained using four DBS were 1.08 pg/50 μl for 6β-OHF and 1.01 pg/50 μl for cortisol. The 6β-OHF and cortisol in DBS were stable for 28 days at room temperature. The intraday and interday accuracy and precision of the method was <12%. Additionally, the 6β-OHF and cortisol in DBS were measured before, during, and after 3 days of clarithromycin administration to two of the subjects. Then, their concentration was compared in the plasma and whole blood collected simultaneously. The concentrations of 6β-OHF and cortisol in four DBS ranged from 0.007 to 0.079 ng/50 μl and from 1.15 to 6.66 ng/50 μl, respectively. The 6β-OHF/cortisol ratio in DBS decreased by approximately 50% on administering clarithromycin compared with that before the administration of clarithromycin. The 6β-OHF/cortisol ratio in DBS also showed a strong correlation with that in whole blood (r = 0.9694) and plasma (r = 0.9383). This method provides high accuracy and precision for measuring 6β-OHF and cortisol in DBS. It also allows the use of DBS instead of plasma for calculating the 6β-OHF/cortisol ratio. The 6β-OHF/cortisol ratio could be an index of CYP3A activity in clinical setting.
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Affiliation(s)
- Ryohei Hirano
- Laboratory of Clinical Pharmacy and Experimental Therapeutics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Akitomo Yokokawa
- Laboratory of Clinical Pharmacy and Experimental Therapeutics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Tomomi Furihata
- Laboratory of Clinical Pharmacy and Experimental Therapeutics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hiromi Shibasaki
- Laboratory of Clinical Pharmacy and Experimental Therapeutics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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Carpentieri D, Colvard A, Petersen J, Marsh W, David-Dirgo V, Huentelman M, Pirrotte P, Sivakumaran TA. Mind the Quality Gap When Banking on Dry Blood Spots. Biopreserv Biobank 2021; 19:136-142. [PMID: 33567235 DOI: 10.1089/bio.2020.0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Dry blood spots (DBS) offer many advantages over other blood banking protocols due to the reduction of time and equipment needed for collection and the ease of processing, storage, and shipment. In addition, the sample size makes it a very attractive method when considering the banking of small pediatric samples. On that note, the Centers for Disease Control and Prevention (CDC) preanalytical standards for DBS are commonly used in the worldwide mass spectrometry-based inborn errors of metabolism screening programs. However, these guidelines may not apply for analytes and protocols not included in these programs. In fact, the availability of leftover samples and the ongoing interest in protocols outside this scenario are providing us with new DBS biobanking insights. Herein, we review the literature for indicators that should be considered in the design of prospective fit for purpose DBS biobanks, especially for those focused mostly on pediatric and OMIC platforms.
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Affiliation(s)
- David Carpentieri
- Department of Pathology and Laboratory Medicine, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Amber Colvard
- Department of Pathology, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Jackie Petersen
- Department of Pathology, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - William Marsh
- Department of Biorepository, Mayo Clinic, Phoenix, Arizona, USA
| | - Victoria David-Dirgo
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - Matt Huentelman
- Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - Patrick Pirrotte
- Collaborative Center for Translational Mass Spectrometry, The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - T A Sivakumaran
- Department of Pathology, Clinical Genomics, Phoenix Children's Hospital, Phoenix, Arizona, USA
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3
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Acquavia MA, Foti L, Pascale R, Nicolò A, Brancaleone V, Cataldi TRI, Martelli G, Scrano L, Bianco G. Detection and quantification of Covid-19 antiviral drugs in biological fluids and tissues. Talanta 2020; 224:121862. [PMID: 33379073 PMCID: PMC7642756 DOI: 10.1016/j.talanta.2020.121862] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022]
Abstract
Since coronavirus disease 2019 (COVID-19) started as a fast-spreading pandemic, causing a huge number of deaths worldwide, several therapeutic options have been tested to counteract or reduce the clinical symptoms of patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, no specific drugs for COVID-19 are available, but many antiviral agents have been authorised by several national agencies. Most of them are under investigation in both preclinical and clinical trials; however, pharmacokinetic and metabolism studies are needed to identify the most suitable dose to achieve the desired effect on SARS-CoV-2. Therefore, the efforts of the scientific community have focused on the screening of therapies able to counteract the most severe effects of the infection, as well as on the search of sensitive and selective analytical methods for drug detection in biological matrices, both fluids and tissues. In the last decade, many analytical methods have been proposed for the detection and quantification of antiviral compounds currently being tested for COVID-19 treatment. In this review, a critical discussion on the overall analytical procedure is provided, i.e (a) sample pre-treatment and extraction methods such as protein precipitation (PP), solid-phase extraction (SPE), liquid–liquid extraction (LLE), ultrasound-assisted extraction (UAE) and QuEChERS (quick, easy, cheap, effective, rugged and safe), (b) detection and quantification methods such as potentiometry, spectrofluorimetry and mass spectrometry (MS) as well as (c) methods including a preliminary separation step, such as high performance liquid chromatography (HPLC) and capillary electrophoresis (CE) coupled to UV–Vis or MS detection. Further current trends, advantages and disadvantages and prospects of these methods have been discussed, to help the analytical advances in reducing the harm caused by the SARS-CoV-2 virus. Fourteen antiviral drugs were tested to counteract the effects of COVID-19. A review of analytical methods for antivirals detection is presented. Method validation, drugs extraction, separation and detection are discussed. LC-MS and MS/MS is mostly used for accurate and sensitive drugs quantification.
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Affiliation(s)
- Maria A Acquavia
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy; ALMAGISI S.r.l Corso Italia, 27-39100, Bolzano, Italy.
| | - Luca Foti
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy.
| | - Raffaella Pascale
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy.
| | - Antonia Nicolò
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy.
| | - Vincenzo Brancaleone
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy.
| | - Tommaso R I Cataldi
- Università Degli Studi di Bari Aldo Moro, Dipartimento di Chimica, Via E. Orabona, 4-70126, Bari, Italy.
| | - Giuseppe Martelli
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy.
| | - Laura Scrano
- Università Degli Studi Della Basilicata, Dipartimento Delle Culture Europee e Del Mediterraneo: Arch., Ambiente, Patrimoni Culturali, Via Lanera, 20-75100, Matera, Italy.
| | - Giuliana Bianco
- Università Degli Studi Della Basilicata, Dipartimento di Scienze, Via Dell'Ateneo Lucano, 10-85100, Potenza, Italy.
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Challa GN, Nimmu NV, Bondigalla R, Arnipalli MS. Bioassay studies of Risperidone and its active metabolite in rat dried blood spots and dried plasma spots using LC‐ESI‐MS/MS: Comparison of their pharmacokinetic profiles. SEPARATION SCIENCE PLUS 2020. [DOI: 10.1002/sscp.202000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Gangu Naidu Challa
- Vignan's Foundation For Science Technology & Research (VFSTRU) (Deemed to be University) Vadlamudi Guntur Andhra Pradesh India
| | - Narendra Varma Nimmu
- D‐216, Discovery Lab Analytical Chemistry Division Indian Institute of Chemical Technology Tarnaka Hyderabad India
| | | | - Manikanta Swamy Arnipalli
- D‐216, Discovery Lab Analytical Chemistry Division Indian Institute of Chemical Technology Tarnaka Hyderabad India
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Huang MF, Lin YR, Chang YT, Shiue YL, Liang SS. Reductive amination assistance for quantification of oseltamivir phosphate and oseltamivir carboxylate by HPLC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1087-1088:23-28. [PMID: 29702353 DOI: 10.1016/j.jchromb.2018.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/13/2018] [Accepted: 03/24/2018] [Indexed: 12/15/2022]
Abstract
Oseltamivir phosphate (OP) is the first line therapy for influenza, and its primary metabolite oseltamivir carboxylate (OC) is the active agent via inhibition of neuraminidase of influenza virus. Dosages of OP and OC might affect human causing nausea and vomiting and it is therefore necessary to evaluate their toxicity and safety. The separation system: liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a powerful technique to monitor OP and OC. However, quantification of OP and OC needs isotopic analogs as internal standards to monitor the stability of the sample pretreatment procedures and instruments. In this study, we demonstrated a modified method (i.e., reductive amination) to synthesize OP and OC deuterated and hydrogenated analogs as internal standards (ISs) and for illustration of calibration curves, respectively. This modification allowed to overcome ISs selection and to enhance the signal intensities via high yield reductive amination in MS detection. We utilized the multiple reaction monitoring (MRM) mode to target m/z values of precursor and product ions. N-dimethylated OP and N-dimethylated OC showed linearity ranging from 1 to 1000 ng/mL with coefficient of determination (R2) values of 0.9995 and 0.9999, respectively. Additionally, the relative standard deviations (RSD) of intra-day ranged from 0.3% to 5.2%, and the RSD of inter-day ranged from 2.0% to 18.8%, respectively. This quantitative method utilized spiked OP and OC at low (20 ng/mL), intermediate (100 ng/mL), and high (500 ng/mL) concentrations in human serum samples. The average recoveries for OP and OC were 84.6%-107.7% and 94.9%-98.5%, respectively.
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Affiliation(s)
- Mei-Fang Huang
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Reng Lin
- Department of Biotechnology, School of Environment and Life Sciences, Fooyin University, Kaohsiung, Taiwan
| | - Yu-Tzu Chang
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shih-Shin Liang
- Department of Biotechnology, College of Life Science, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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6
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Lehmann S, Picas A, Tiers L, Vialaret J, Hirtz C. Clinical perspectives of dried blood spot protein quantification using mass spectrometry methods. Crit Rev Clin Lab Sci 2017; 54:173-184. [DOI: 10.1080/10408363.2017.1297358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sylvain Lehmann
- Laboratory of Biochemistry and Clinical Proteomics, CHU Montpellier, Institute of Regenerative Medicine & Biotherapy, Montpellier, France
| | - Alexia Picas
- Laboratory of Biochemistry and Clinical Proteomics, CHU Montpellier, Institute of Regenerative Medicine & Biotherapy, Montpellier, France
| | - Laurent Tiers
- Laboratory of Biochemistry and Clinical Proteomics, CHU Montpellier, Institute of Regenerative Medicine & Biotherapy, Montpellier, France
| | - Jerome Vialaret
- Laboratory of Biochemistry and Clinical Proteomics, CHU Montpellier, Institute of Regenerative Medicine & Biotherapy, Montpellier, France
| | - Christophe Hirtz
- Laboratory of Biochemistry and Clinical Proteomics, CHU Montpellier, Institute of Regenerative Medicine & Biotherapy, Montpellier, France
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Zakaria R, Allen KJ, Koplin JJ, Roche P, Greaves RF. Advantages and Challenges of Dried Blood Spot Analysis by Mass Spectrometry Across the Total Testing Process. EJIFCC 2016; 27:288-317. [PMID: 28149263 PMCID: PMC5282914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Through the introduction of advanced analytical techniques and improved throughput, the scope of dried blood spot testing utilising mass spectrometric methods, has broadly expanded. Clinicians and researchers have become very enthusiastic about the potential applications of dried blood spot based mass spectrometric applications. Analysts on the other hand face challenges of sensitivity, reproducibility and overall accuracy of dried blood spot quantification. In this review, we aim to bring together these two facets to discuss the advantages and current challenges of non-newborn screening applications of dried blood spot quantification by mass spectrometry. METHODS To address these aims we performed a key word search of the PubMed and MEDLINE online databases in conjunction with individual manual searches to gather information. Keywords for the initial search included; "blood spot" and "mass spectrometry"; while excluding "newborn"; and "neonate". In addition, databases were restricted to English language and human specific. There was no time period limit applied. RESULTS As a result of these selection criteria, 194 references were identified for review. For presentation, this information is divided into: 1) clinical applications; and 2) analytical considerations across the total testing process; being pre-analytical, analytical and post-analytical considerations. CONCLUSIONS DBS analysis using MS applications is now broadly applied, with drug monitoring for both therapeutic and toxicological analysis being the most extensively reported. Several parameters can affect the accuracy of DBS measurement and further bridge experiments are required to develop adjustment rules for comparability between dried blood spot measures and the equivalent serum/plasma values. Likewise, the establishment of independent reference intervals for dried blood spot sample matrix is required.
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Affiliation(s)
- Rosita Zakaria
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia,Clinical Biochemistry, Austin Pathology, Heidelberg, Victoria, Australia,Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Katrina J. Allen
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia, Department of Allergy and Clinical Immunology, Royal Children’s Hospital, Parkville, Victoria, Australia
| | | | - Peter Roche
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ronda F. Greaves
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia,Murdoch Children’s Research Institute, Parkville, Victoria, Australia,School of Health and Biomedical Sciences RMIT University PO Box 71, Bundoora, Victoria, 3083 Australia +61 (0)399257080
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8
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Antunes MV, Charão MF, Linden R. Dried blood spots analysis with mass spectrometry: Potentials and pitfalls in therapeutic drug monitoring. Clin Biochem 2016; 49:1035-46. [PMID: 27179588 DOI: 10.1016/j.clinbiochem.2016.05.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 01/13/2023]
Abstract
Therapeutic drug monitoring (TDM) relays in the availability of specialized laboratory assays, usually available in reference centers that are not accessible to all patients. In this context, there is a growing interest in the use of dried blood spot (DBS) sampling, usually obtained from finger pricks, which allows simple and cost-effective logistics in many settings, particularly in Developing Countries. The use of DBS assays to estimate plasma concentrations is highly dependent on the hematocrit of the blood, as well as the particular characteristics of the measured analyte. DBS assays require specific validation assays, most of them are related to hematocrit effects. In the present manuscript, the application of mass spectrometric assays for determination of drugs for TDM purposes in the last ten years is reviewed, as well as the particular validation assays for new DBS methods.
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Affiliation(s)
- Marina Venzon Antunes
- Toxicological Analysis Laboratory, Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | - Mariele Feiffer Charão
- Toxicological Analysis Laboratory, Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil
| | - Rafael Linden
- Toxicological Analysis Laboratory, Instituto de Ciências da Saúde, Universidade Feevale, Novo Hamburgo, RS, Brazil.
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Wagner M, Tonoli D, Varesio E, Hopfgartner G. The use of mass spectrometry to analyze dried blood spots. MASS SPECTROMETRY REVIEWS 2016; 35:361-438. [PMID: 25252132 DOI: 10.1002/mas.21441] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Dried blood spots (DBS) typically consist in the deposition of small volumes of capillary blood onto dedicated paper cards. Comparatively to whole blood or plasma samples, their benefits rely in the fact that sample collection is easier and that logistic aspects related to sample storage and shipment can be relatively limited, respectively, without the need of a refrigerator or dry ice. Originally, this approach has been developed in the sixties to support the analysis of phenylalanine for the detection of phenylketonuria in newborns using bacterial inhibition test. In the nineties tandem mass spectrometry was established as the detection technique for phenylalanine and tyrosine. DBS became rapidly recognized for their clinical value: they were widely implemented in pediatric settings with mass spectrometric detection, and were closely associated to the debut of newborn screening (NBS) programs, as a part of public health policies. Since then, sample collection on paper cards has been explored with various analytical techniques in other areas more or less successfully regarding large-scale applications. Moreover, in the last 5 years a regain of interest for DBS was observed and originated from the bioanalytical community to support drug development (e.g., PK studies) or therapeutic drug monitoring mainly. Those recent applications were essentially driven by improved sensitivity of triple quadrupole mass spectrometers. This review presents an overall view of all instrumental and methodological developments for DBS analysis with mass spectrometric detection, with and without separation techniques. A general introduction to DBS will describe their advantages and historical aspects of their emergence. A second section will focus on blood collection, with a strong emphasis on specific parameters that can impact quantitative analysis, including chromatographic effects, hematocrit effects, blood effects, and analyte stability. A third part of the review is dedicated to sample preparation and will consider off-line and on-line extractions; in particular, instrumental designs that have been developed so far for DBS extraction will be detailed. Flow injection analysis and applications will be discussed in section IV. The application of surface analysis mass spectrometry (DESI, paper spray, DART, APTDCI, MALDI, LDTD-APCI, and ICP) to DBS is described in section V, while applications based on separation techniques (e.g., liquid or gas chromatography) are presented in section VI. To conclude this review, the current status of DBS analysis is summarized, and future perspectives are provided.
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Affiliation(s)
- Michel Wagner
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - David Tonoli
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - Emmanuel Varesio
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
| | - Gérard Hopfgartner
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Life Sciences Mass Spectrometry, Quai Ernest-Ansermet 30, 1211, Geneva, Switzerland
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10
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Procedures and practices for the validation of bioanalytical methods using dried blood spots: a review. Bioanalysis 2014; 6:2481-514. [DOI: 10.4155/bio.14.185] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Dried blood spot (DBS) sampling, the collection of whole blood samples on paper, is an emerging technique used for bioanalytical methods. Several analytical challenges, such as possible effects of spotting volume, hematocrit and spot inhomogeneity are identified for these methods, however, no regulatory-based guidelines for the specific validation of DBS-based assays are available hitherto. To date, 68 validation reports concerning methods for the quantitative determination of drugs in human DBS could be traced in the literature, with large differences in the extensiveness of the reported validations. This review aims to present an overview of these published validations. Additionally, the different challenges of DBS-based assays are discussed and recommendations on how to perform validation tests addressing these challenges are provided.
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11
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Assessment of the within- and between-lot variability of Whatman™ FTA(®) DMPK and 903(®) DBS papers and their suitability for the quantitative bioanalysis of small molecules. Bioanalysis 2014; 5:2613-30. [PMID: 24180503 DOI: 10.4155/bio.13.227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To ensure that PK data generated from DBS samples are of the highest quality, it is important that the paper substrate is uniform and does not unduly contribute to variability. This study investigated any within and between lot variations for four cellulose paper types: Whatman™ FTA(®) DMPK-A, -B and -C, and 903(®) (GE Healthcare, Buckinghamshire, UK). The substrates were tested to demonstrate manufacturing reproducibility (thickness, weight, chemical coating concentration) and its effect on the size of the DBS produced, and the quantitative data derived from the bioanalysis of human DBS samples containing six compounds of varying physicochemical properties. RESULTS & DISCUSSION Within and between lot variations in paper thickness, mass and chemical coating concentration were within acceptable manufacturing limits. No variation in the spot size or bioanalytical data was observed. CONCLUSION Bioanalytical results obtained for DBS samples containing a number of analytes spanning a range of chemical space are not affected by the lot used or by the location within a lot.
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Sharma A, Jaiswal S, Shukla M, Lal J. Dried blood spots: Concepts, present status, and future perspectives in bioanalysis. Drug Test Anal 2014; 6:399-414. [DOI: 10.1002/dta.1646] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/22/2014] [Accepted: 02/24/2014] [Indexed: 01/14/2023]
Affiliation(s)
- Abhisheak Sharma
- Pharmacokinetics & Metabolism Division; CSIR-Central Drug Research Institute; Lucknow 226031 India
- Academy of Scientific and Innovative Research; New Delhi India
| | - Swati Jaiswal
- Pharmacokinetics & Metabolism Division; CSIR-Central Drug Research Institute; Lucknow 226031 India
- Academy of Scientific and Innovative Research; New Delhi India
| | - Mahendra Shukla
- Pharmacokinetics & Metabolism Division; CSIR-Central Drug Research Institute; Lucknow 226031 India
- Academy of Scientific and Innovative Research; New Delhi India
| | - Jawahar Lal
- Pharmacokinetics & Metabolism Division; CSIR-Central Drug Research Institute; Lucknow 226031 India
- Academy of Scientific and Innovative Research; New Delhi India
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Rincón JP, Meesters RJW. Evaluation of peripheral blood microsampling techniques in combination with liquid chromatography-high resolution mass spectrometry for the determination of drug pharmacokinetics in clinical studies. Drug Test Anal 2013; 6:568-77. [PMID: 24259410 DOI: 10.1002/dta.1582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 09/30/2013] [Accepted: 10/14/2013] [Indexed: 01/21/2023]
Abstract
New bioanalytical assays were developed, validated, and applied in a clinical study for quantitative measurement of acetaminophen concentrations in blood and plasma samples. Furthermore, after validation, the bioanalytical assays were used for determination of pharmacokinetics within a group of six healthy male human volunteers after admission of a single oral dose of 500 mg of acetaminophen. Quantitative analyses were done by means of liquid chromatography-high resolution mass spectrometry and blood samples were collected at various sampling time points using different peripheral blood microsampling techniques. Post-dose peripheral collected blood samples were applied for the preparation of dry blood spots, dried matrix on paper discs, and peripheral plasma. Pharmacokinetic parameters determined were clearance (Cl), area under the curve (AUC), volume of distribution (Vd ), peak concentration (Cmax ), time of occurrence of peak concentration (Tmax ) and half-life time (T½ ). Observed pharmacokinetic values were not statistically (ANOVA) different compared to in literature reported values based on venous blood collection. The present pilot study demonstrated the feasibility of peripheral blood microsampling techniques in combination with quantitative liquid chromatography-high resolution mass spectrometry analysis for the determination of pharmacokinetics in clinical studies.
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Affiliation(s)
- Juan P Rincón
- Grupo de Investigación en Química Analítica y Bioanalítica (GABIO), Universidad de los Andes, Cra. 1 No. 18ª-10, Bogotá D.C., Colombia
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14
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State-of-the-art dried blood spot analysis: an overview of recent advances and future trends. Bioanalysis 2013; 5:2187-208. [DOI: 10.4155/bio.13.175] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dried blood spots have become a popular method in a variety of micro blood-sampling techniques in the life sciences sector, consequently competing with the field of conventional, invasive blood sampling by venepuncture. Dried blood spots are widely applied in numerous bioanalytical assays and have gained a significant role in the screening of inherited metabolic diseases, in PK and PD modeling; in the treatment and diagnosis of infectious diseases; and in therapeutic drug monitoring. Recent technological developments such as automation, online extraction, mass spectrometric direct analysis and also conventional dried blood spot bioanalysis, as well as future developments in dried blood spot bioanalysis are highlighted and presented in this article.
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15
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van der Vries E, Stittelaar KJ, van Amerongen G, Veldhuis Kroeze EJB, de Waal L, Fraaij PLA, Meesters RJ, Luider TM, van der Nagel B, Koch B, Vulto AG, Schutten M, Osterhaus ADME. Prolonged influenza virus shedding and emergence of antiviral resistance in immunocompromised patients and ferrets. PLoS Pathog 2013; 9:e1003343. [PMID: 23717200 PMCID: PMC3662664 DOI: 10.1371/journal.ppat.1003343] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/21/2013] [Indexed: 01/17/2023] Open
Abstract
Immunocompromised individuals tend to suffer from influenza longer with more serious complications than otherwise healthy patients. Little is known about the impact of prolonged infection and the efficacy of antiviral therapy in these patients. Among all 189 influenza A virus infected immunocompromised patients admitted to ErasmusMC, 71 were hospitalized, since the start of the 2009 H1N1 pandemic. We identified 11 (15%) cases with prolonged 2009 pandemic virus replication (longer than 14 days), despite antiviral therapy. In 5 out of these 11 (45%) cases oseltamivir resistant H275Y viruses emerged. Given the inherent difficulties in studying antiviral efficacy in immunocompromised patients, we have infected immunocompromised ferrets with either wild-type, or oseltamivir-resistant (H275Y) 2009 pandemic virus. All ferrets showed prolonged virus shedding. In wild-type virus infected animals treated with oseltamivir, H275Y resistant variants emerged within a week after infection. Unexpectedly, oseltamivir therapy still proved to be partially protective in animals infected with resistant virus. Immunocompromised ferrets offer an attractive alternative to study efficacy of novel antiviral therapies. Immunocompromised patients, such as transplant recipients on immune suppressive therapy, are a substantial and gradually expanding patient group. Upon influenza virus infection, these patients clear the virus less efficiently and are more likely to develop severe pneumonia than immunocompetent individuals. Existing antiviral strategies are far from satisfactory for this patient group, as they show limited effectiveness with frequent emergence of antiviral resistance. For ethical and practical reasons antiviral efficacy studies are hard to conduct in these patients. Therefore, we developed an immunocompromised ferret, mimicking an immune suppressive regimen used for solid organ transplant recipients. Upon infection with 2009 pandemic influenza A/H1N1 virus these animals, like immunocompromised patients, develop severe respiratory disease with prolonged virus excretion. Interestingly, all immunocompromised ferrets on oseltamivir therapy excreted oseltamivir resistant viruses (H275Y) within one week after start of treatment. Furthermore, high dose oseltamivir therapy still proved to be partially effective against these oseltamivir resistant viruses. These immunocompromised ferrets provide a useful tool in the development of novel antiviral approaches for immunocompromised patients suffering from influenza.
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Affiliation(s)
| | | | | | | | - Leon de Waal
- Viroclinics Biosciences B.V., Rotterdam, The Netherlands
| | - Pieter L. A. Fraaij
- Department of Virology, ErasmusMC, Rotterdam, The Netherlands
- Department of Paediatrics, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | | | - Theo M. Luider
- Department of Neurology, ErasmusMC, Rotterdam, The Netherlands
| | | | - Birgit Koch
- Department of Hospital Pharmacy, ErasmusMC, Rotterdam, The Netherlands
| | - Arnold G. Vulto
- Department of Hospital Pharmacy, ErasmusMC, Rotterdam, The Netherlands
| | - Martin Schutten
- Department of Virology, ErasmusMC, Rotterdam, The Netherlands
| | - Albert D. M. E. Osterhaus
- Department of Virology, ErasmusMC, Rotterdam, The Netherlands
- Viroclinics Biosciences B.V., Rotterdam, The Netherlands
- * E-mail:
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Núñez O, Gallart-Ayala H, Martins CP, Lucci P, Busquets R. State-of-the-art in fast liquid chromatography–mass spectrometry for bio-analytical applications. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 927:3-21. [DOI: 10.1016/j.jchromb.2012.12.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/03/2012] [Accepted: 12/08/2012] [Indexed: 11/29/2022]
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Ross RS, Stambouli O, Grüner N, Marcus U, Cai W, Zhang W, Zimmermann R, Roggendorf M. Detection of infections with hepatitis B virus, hepatitis C virus, and human immunodeficiency virus by analyses of dried blood spots--performance characteristics of the ARCHITECT system and two commercial assays for nucleic acid amplification. Virol J 2013; 93:309-21. [PMID: 23497102 DOI: 10.1016/j.antiviral.2011.12.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 12/09/2011] [Accepted: 12/19/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nowadays, dried blood spots (DBS) are primarily used to obtain diagnostic access to risk collectives such as intravenous drug users, who are prone to infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Before DBS analyses can be used in this diagnostic context, however, a comprehensive evaluation of its performance characteristics must be conducted. To the best of our knowledge, the current study presents for the first time such essential data for the Abbott ARCHITECT system, which is currently the worldwide leading platform in this field of infection diagnostics. METHODS The investigation comprised 1,762 paired serum/DBS samples and a total of 3,524 determinations with the Abbott ARCHITECT HBsAg, anti-HBc, anti-HBs, anti-HCV and HIV-1-p24-antigen/anti-HIV 1/2 assays as well as with the artus HBV LC PCR and VERSANT HCV RNA qualitative (TMA) tests. RESULTS In the context of DBS testing, a specificity of 100% was recorded for the seven serological and molecular biological assays. The analytical sensitivity of HBsAg, anti-HBc, anti-HBs, anti-HCV, HIV-1-p24-antigen/anti-HIV 1/2, HBV DNA, and HCV RNA detections in DBS eluates was 98.6%, 97.1%, 97.5%, 97.8%, 100%, 93%, and 100%, respectively. DISCUSSION/CONCLUSIONS The results obtained indicate that it is today possible to reliably detect HBsAg, anti-HBc, anti-HBs, anti-HCV and HIV-1-p24 antigen/anti-HIV 1/2 with state-of-the-art analytical systems such as the Abbott ARCHITECT in DBS eluates even when a comparatively high elution volume of 1,000 μl is used. They also provide evidence for the inherent analytical limits of DBS testing, which primarily concern the anti-HBc/anti-HBs system for individuals with HIV infections and nucleic acid tests with relatively low analytical sensitivity.
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Affiliation(s)
- R Stefan Ross
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Blessborn D, Sköld K, Zeeberg D, Kaewkhao K, Sköld O, Ahnoff M. Heat stabilization of blood spot samples for determination of metabolically unstable drug compounds. Bioanalysis 2013; 5:31-9. [PMID: 23256470 PMCID: PMC4024484 DOI: 10.4155/bio.12.294] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sample stability is critical for accurate analysis of drug compounds in biosamples. The use of additives to eradicate the enzymatic activity causing loss of these analytes has its limitations. RESULTS A novel technique for sample stabilization by rapid, high-temperature heating was used. The stability of six commercial drugs in blood and blood spots was investigated under various conditions with or without heat stabilization at 95°C. Oseltamivir, cefotaxime and ribavirin were successfully stabilized by heating whereas significant losses were seen in unheated samples. Amodiaquine was stable with and without heating. Artemether and dihydroartemisinin were found to be very heat sensitive and began to decompose even at 60°C. CONCLUSION Heat stabilization is a viable technique to maintain analytes in blood spot samples, without the use of chemical additives, by stopping the enzymatic activity that causes sample degradation.
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Affiliation(s)
- Daniel Blessborn
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | | | - Karnrawee Kaewkhao
- Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | | | - Martin Ahnoff
- Denator AB, Gothenburg, Sweden
- Regulatory Bioanalysis, AstraZeneca R&D Mölndal, Sweden
- Chemistry & Molecular Biology, University of Gothenburg, Sweden
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Ramesh T, Nageswara Rao P, Nageswara Rao R, Satyanarayana KVV. Hydrophilic interaction liquid chromatography for the determination of vesnarinone on dried blood spots; application to pharmacokinetics in rats. NEW J CHEM 2013. [DOI: 10.1039/c3nj00497j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Plamen A. Demirev
- Johns Hopkins University Applied Physics Laboratory, Laurel,
Maryland 20723, United States
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Simple and sensitive assay for quantification of oseltamivir and its active metabolite oseltamivir carboxylate in human plasma using high-performance liquid chromatography coupled with electrospray ionization tandem mass spectrometry: improved applicability to pharmacokinetic study. J Pharm Biomed Anal 2012; 72:245-50. [PMID: 23000242 DOI: 10.1016/j.jpba.2012.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 08/27/2012] [Accepted: 08/29/2012] [Indexed: 11/20/2022]
Abstract
Although liquid chromatography/electrospray ionization tandem mass spectrometry-based assays have been reported for the measurement of the antiviral oseltamivir (OS) in human samples, these assays either involve complicated sample pretreatment or lack sensitivity. Here we introduce a straightforward approach to improve the assay performance for OS and its metabolite oseltamivir carboxylate (OSC) in human plasma. A very low concentration of mobile phase modifier can improve the ionization efficiency of both analytes, thus enabling a high sensitivity without any matrix effect. The fast LC gradient further increases the sensitivity by narrowing the peak width (6-9s) and eluting the analytes at higher organic content. The increased ionization efficiency and minimized matrix effects enabled us to introduce a one-step protein precipitation for sample clean-up without compromising the sensitivity. The lower limit of quantification was 0.34 ng/mL for both analytes, which was at least 3 times more sensitive than published assays that involve complicated sample pretreatment. The assay involves measurement of analytes and their stable-isotope internal standards in small-volume (30-μL) plasma. Sodium fluoride was utilized to prevent the hydrolysis of OS during and after sampling. The calibration curve was linear over the range of 0.34-1000 ng/mL. Accuracy was 95-110% and the precision was 2.2-11.0%. This method was applied successfully to the human pharmacokinetic study of OS, and can estimate the relevant pharmacokinetic parameters of OS with more accuracy. The approach utilized in the optimization of assay performance can be extended to the measurement of other drugs in biomatrices.
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Ansari M, Uppugunduri CRS, Déglon J, Théorêt Y, Versace F, Gumy-Pause F, Ozsahin H, Dayer P, Desmules J, Daali Y. A simplified method for busulfan monitoring using dried blood spot in combination with liquid chromatography/tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2012; 26:1437-1446. [PMID: 22592987 DOI: 10.1002/rcm.6241] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
RATIONALE Busulfan (Bu) is an important component of the myeloablative conditioning regimen prior to hematopoietic stem cell transplantation (HSCT) especially in children. Intravenously administered Bu exhibits a therapeutic window phenomenon requiring therapeutic drug monitoring. Analytical methods developed for Bu routine monitoring were aimed at using low volumes of biological fluids and development of simple procedures to facilitate the dosage adjustment. In this report, we describe a simple, rapid method for Bu measurement using dried blood spots (DBS) from only 5 μL of whole blood. METHODS Bu extracted from DBS with methanol was measured by high-performance liquid chromatography with electrospray ionization and tandem mass spectrometry in multiple reaction monitoring mode using D8-Bu as an internal standard. The method was in-house validated evaluating trueness, repeatability, within-laboratory reproducibility, specificity and the lower limit of quantification (LLOQ). RESULTS The method was linear in the calibration range of 100-2000 ng mL(-1) (r(2)>0.99) encompassing the therapeutic concentrations of Bu. A good trueness (<14%), precision (<10%), and recovery (100%) were observed during validation of the method with quality controls of 300, 600 and 1400 ng mL(-1). The LLOQ was determined as 50 ng mL(-1) and no matrix or carryover effects were observed. The validated method was applied to measure Bu levels in four children receiving infusion of Bu prior to HSCT. A good correlation was observed between the Bu levels measured by DBS and dried plasma spot (DPS) (r(2) =0.96) and between DPS and the GC/MS method (r(2) =0.92). Bu was found to be stable in DBS up to 6 h at room temperature and for 24 h at 4 °C. CONCLUSIONS The new DBS method facilitates earlier dosage adjustment during Bu therapy by its specific and simple procedure using 5 μL of whole blood.
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Affiliation(s)
- Marc Ansari
- Department of Pediatrics, Onco-hematology Unit, Geneva University Hospitals, Geneva, Switzerland
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Liquid chromatography-mass spectrometric determination of losartan and its active metabolite on dried blood spots. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 902:47-54. [PMID: 22770781 DOI: 10.1016/j.jchromb.2012.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 06/08/2012] [Accepted: 06/13/2012] [Indexed: 11/21/2022]
Abstract
A simple and rapid quantitative bioanalytical liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for simultaneous determination of losartan and its active metabolite, losartan carboxylic acid on rat dried blood spots was developed and validated as per regulatory guidelines. Losartan and its metabolite were extracted from dried blood spots using 50% aqueous methanol and separated on Waters XTerra(®) RP18 (250 mm × 4.6 mm, 5 μm) column using mobile phase composed of 40% acetonitrile and 60% aqueous ammonium acetate (10mM). The eluents were monitored using ESI tandem mass spectrometric detection with negative polarity in MRM mode using ion transitions m/z 421.2→179.0, m/z 435.3→157.0 and m/z 427.3→193.0 for losartan, losartan carboxylic acid and Irbesartan (internal standard), respectively. The method was validated over the linear range of 1-200 ng/mL and 5-1000 ng/mL with lower limits of quantification of 1.0 ng/mL and 5.0 ng/mL for losartan and losartan carboxylic acid, respectively. Inter and intra-day precision and accuracy (Bias) were below 5.96% and between -2.8 and 1.5%, respectively. The mean recoveries of the analytes from dried blood spots were between 89% and 97%. No significant carry over and matrix effects were observed. The stability of stock solution, whole blood, dried blood spot and processed samples were tested under different conditions and the results were found to be well within the acceptable limits. Additional validation parameters such as influence of hematocrit and spot volume were also evaluated and found to be well within the acceptable limits.
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Rapid LC–MS/MS quantification of the major benzodiazepines and their metabolites on dried blood spots using a simple and cost-effective sample pretreatment. Bioanalysis 2012; 4:1337-50. [DOI: 10.4155/bio.12.42] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Dried blood spots (DBS) sampling has gained popularity in the bioanalytical community as an alternative to conventional plasma sampling, as it provides numerous benefits in terms of sample collection and logistics. The aim of this work was to show that these advantages can be coupled with a simple and cost-effective sample pretreatment, with subsequent rapid LC–MS/MS analysis for quantitation of 15 benzodiazepines, six metabolites and three Z-drugs. For this purpose, a simplified offline procedure was developed that consisted of letting a 5-µl DBS infuse directly into 100 µl of MeOH, in a conventional LC vial. Results: The parameters related to the DBS pretreatment, such as extraction time or internal standard addition, were investigated and optimized, demonstrating that passive infusion in a regular LC vial was sufficient to quantitatively extract the analytes of interest. The method was validated according to international criteria in the therapeutic concentration ranges of the selected compounds. Conclusion: The presented strategy proved to be efficient for the rapid analysis of the selected drugs. Indeed, the offline sample preparation was reduced to a minimum, using a small amount of organic solvent and consumables, without affecting the accuracy of the method. Thus, this approach enables simple and rapid DBS analysis, even when using a non-DBS-dedicated autosampler, while lowering the costs and environmental impact.
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Development and validation of a fully automated online human dried blood spot analysis of bosentan and its metabolites using the Sample Card And Prep DBS System. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 885-886:50-60. [DOI: 10.1016/j.jchromb.2011.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/10/2011] [Accepted: 12/13/2011] [Indexed: 11/20/2022]
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Impact of internal standard addition on dried blood spot analysis in bioanalytical method development. Bioanalysis 2011; 3:2357-64. [DOI: 10.4155/bio.11.202] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Addition of internal standards to dried blood spot (DBS) specimens can be complicated. Therefore, we studied the feasibility of different internal standard addition procedures. Nevirapine and its stable-isotope analogue were used as model compounds and concentrations in DBS specimen were determined by matrix-assisted laser desorption/ionization-triple quadrupole tandem mass spectrometry using selected reaction monitoring. Results: The addition procedure of the stable isotope-labeled internal standard had significant impact on observed nevirapine concentrations. Relative recovery rates depending on the internal standard addition procedure ranged between 11.4 and 107.9%. Experiments with different punch sizes (5 and 7 mm diameter) showed no significant influence on observed nevirapine concentrations. Conclusion: Application of internal standard prior to blood spotting provided good nevirapine recoveries and this procedure is well suited for applying DBS in infectious diseases, especially in HIV-infection treatment.
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