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Chamorro-Garcia A, Gerson J, Flatebo C, Fetter L, Downs AM, Emmons N, Ennis HL, Milosavić N, Yang K, Stojanovic M, Ricci F, Kippin TE, Plaxco KW. Real-Time, Seconds-Resolved Measurements of Plasma Methotrexate In Situ in the Living Body. ACS Sens 2023; 8:150-157. [PMID: 36534756 DOI: 10.1021/acssensors.2c01894] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dose-limiting toxicity and significant patient-to-patient pharmacokinetic variability often render it difficult to achieve the safe and effective dosing of drugs. This is further compounded by the slow, cumbersome nature of the analytical methods used to monitor patient-specific pharmacokinetics, which inevitably rely on blood draws followed by post-facto laboratory analysis. Motivated by the pressing need for improved "therapeutic drug monitoring", we are developing electrochemical aptamer-based (EAB) sensors, a minimally invasive biosensor architecture that can provide real-time, seconds-resolved measurements of drug levels in situ in the living body. A key advantage of EAB sensors is that they are generalizable to the detection of a wide range of therapeutic agents because they are independent of the chemical or enzymatic reactivity of their targets. Three of the four therapeutic drug classes that have, to date, been shown measurable using in vivo EAB sensors, however, bind to nucleic acids as part of their mode of action, leaving open questions regarding the extent to which the approach can be generalized to therapeutics that do not. Here, we demonstrate real-time, in vivo measurements of plasma methotrexate, an antimetabolite (a mode of action not reliant on DNA binding) chemotherapeutic, following human-relevant dosing in a live rat animal model. By providing hundreds of drug concentration values, the resulting seconds-resolved measurements succeed in defining key pharmacokinetic parameters, including the drug's elimination rate, peak plasma concentration, and exposure (area under the curve), with unprecedented 5 to 10% precision. With this level of precision, we easily identify significant (>2-fold) differences in drug exposure occurring between even healthy rats given the same mass-adjusted methotrexate dose. By providing a real-time, seconds-resolved window into methotrexate pharmacokinetics, such measurements can be used to precisely "individualize" the dosing of this significantly toxic yet vitally important chemotherapeutic.
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Affiliation(s)
- Alejandro Chamorro-Garcia
- Department of Chemistry and Biochemistry, University of California Santa Barbara, Santa Barbara, California 93106, United States.,Dipartimento di Scienze e Tecnologie Chimiche, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Julian Gerson
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California 93106, United States
| | - Charlotte Flatebo
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California 93106, United States
| | - Lisa Fetter
- Biomolecular Science and Engineering Program, University of California Santa Barbara, Santa Barbara, California 93106, United States
| | - Alex M Downs
- Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, California 93106, United States
| | - Nicole Emmons
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California 93106, United States
| | - Herbert L Ennis
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University New York, New York, New York 10032, United States
| | - Nenad Milosavić
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University New York, New York, New York 10032, United States
| | - Kyungae Yang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University New York, New York, New York 10032, United States
| | - Milan Stojanovic
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University New York, New York, New York 10032, United States.,Department of Biomedical Engineering and Systems Biology, Columbia University New York, New York, New York 10032, United States
| | - Francesco Ricci
- Dipartimento di Scienze e Tecnologie Chimiche, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Tod E Kippin
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California 93106, United States
| | - Kevin W Plaxco
- Department of Chemistry and Biochemistry, University of California Santa Barbara, Santa Barbara, California 93106, United States.,Biomolecular Science and Engineering Program, University of California Santa Barbara, Santa Barbara, California 93106, United States.,Department of Mechanical Engineering, University of California Santa Barbara, Santa Barbara, California 93106, United States.,Biological Engineering Graduate Program, University of California Santa Barbara, Santa Barbara, California 93106, United States
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Development and Evaluation of a Physiologically Based Pharmacokinetic Model for Predicting Haloperidol Exposure in Healthy and Disease Populations. Pharmaceutics 2022; 14:pharmaceutics14091795. [PMID: 36145543 PMCID: PMC9506126 DOI: 10.3390/pharmaceutics14091795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
The physiologically based pharmacokinetic (PBPK) approach can be used to develop mathematical models for predicting the absorption, distribution, metabolism, and elimination (ADME) of administered drugs in virtual human populations. Haloperidol is a typical antipsychotic drug with a narrow therapeutic index and is commonly used in the management of several medical conditions, including psychotic disorders. Due to the large interindividual variability among patients taking haloperidol, it is very likely for them to experience either toxic or subtherapeutic effects. We intend to develop a haloperidol PBPK model for identifying the potential sources of pharmacokinetic (PK) variability after intravenous and oral administration by using the population-based simulator, PK-Sim. The model was initially developed and evaluated to predict the PK of haloperidol and its reduced metabolite in adult healthy population after intravenous and oral administration. After evaluating the developed PBPK model in healthy adults, it was used to predict haloperidol–rifampicin drug–drug interaction and was extended to tuberculosis patients. The model evaluation was performed using visual assessments, prediction error, and mean fold error of the ratio of the observed-to-predicted values of the PK parameters. The predicted PK values were in good agreement with the corresponding reported values. The effects of the pathophysiological changes and enzyme induction associated with tuberculosis and its treatment, respectively, on haloperidol PK, have been predicted precisely. For all clinical scenarios that were evaluated, the predicted values were within the acceptable two-fold error range.
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Zaporowska-Stachowiak I, Stachowiak-Szymczak K, Oduah MT, Sopata M. Haloperidol in palliative care: Indications and risks. Biomed Pharmacother 2020; 132:110772. [PMID: 33068931 DOI: 10.1016/j.biopha.2020.110772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/27/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022] Open
Abstract
Individual response to medication depends on several factors (age, gender, body weight, general clinical condition, genetics, diet, hydration status, comorbidities, co-administered drugs and their mode of administration, smoking, alcohol overuse, environmental factors, e.g. sunlight) that may contribute to adverse drug reactions even at therapeutic doses. Patients in palliative care are at increased risk of these reactions. Unwanted drug effects diminish the quality of life and may lead to a suboptimal dying process. Haloperidol is one of the three most commonly used drugs in palliative care and the most commonly employed typical antipsychotic. It has also been recommended for inclusion into the palliative care emergency kit of home care teams. As such, it is important to be fully conversant with the indications, benefits, and risks of haloperidol, especially in the context of palliative care.
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Affiliation(s)
- Iwona Zaporowska-Stachowiak
- Department of Pharmacology, Poznan University of Medical Sciences, Rokietnicka 5A Street, Poznań, Poland; Palliative Medicine In-patient Unit, Hospital of Lord's Transfiguration of Poznan University of Medical Sciences, Os. Rusa 55, Poznan, Poland.
| | | | - Mary-Tiffany Oduah
- Poznań University of Medical Sciences, Center for Medical Education in English, Poland
| | - Maciej Sopata
- Palliative Medicine In-patient Unit, Hospital of Lord's Transfiguration of Poznan University of Medical Sciences, Os. Rusa 55, Poznan, Poland; Department of Palliative Medicine, Poznan University of Medical Sciences, Os. Rusa 55, Poznań, Poland
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Dopaminergic Modulation of Human Intertemporal Choice: A Diffusion Model Analysis Using the D2-Receptor Antagonist Haloperidol. J Neurosci 2020; 40:7936-7948. [PMID: 32948675 DOI: 10.1523/jneurosci.0592-20.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
The neurotransmitter dopamine is implicated in diverse functions, including reward processing, reinforcement learning, and cognitive control. The tendency to discount future rewards over time has long been discussed in the context of potential dopaminergic modulation. Here we examined the effect of a single dose of the D2 receptor antagonist haloperidol (2 mg) on temporal discounting in healthy female and male human participants. Our approach extends previous pharmacological studies in two ways. First, we applied combined temporal discounting drift diffusion models to examine choice dynamics. Second, we examined dopaminergic modulation of reward magnitude effects on temporal discounting. Hierarchical Bayesian parameter estimation revealed that the data were best accounted for by a temporal discounting drift diffusion model with nonlinear trialwise drift rate scaling. This model showed good parameter recovery, and posterior predictive checks revealed that it accurately reproduced the relationship between decision conflict and response times in individual participants. We observed reduced temporal discounting and substantially faster nondecision times under haloperidol compared with placebo. Discounting was steeper for low versus high reward magnitudes, but this effect was largely unaffected by haloperidol. Results were corroborated by model-free analyses and modeling via more standard approaches. We previously reported elevated caudate activation under haloperidol in this sample of participants, supporting the idea that haloperidol elevated dopamine neurotransmission (e.g., by blocking inhibitory feedback via presynaptic D2 auto-receptors). The present results reveal that this is associated with an augmentation of both lower-level (nondecision time) and higher-level (temporal discounting) components of the decision process.SIGNIFICANCE STATEMENT Dopamine is implicated in reward processing, reinforcement learning, and cognitive control. Here we examined the effects of a single dose of the D2 receptor antagonist haloperidol on temporal discounting and choice dynamics during the decision process. We extend previous studies by applying computational modeling using the drift diffusion model, which revealed that haloperidol reduced the nondecision time and reduced impulsive choice compared with placebo. These findings are compatible with a haloperidol-induced increase in striatal dopamine (e.g., because of a presynaptic mechanism). Our data provide novel insights into the contributions of dopamine to value-based decision-making and highlight how comprehensive model-based analyses using sequential sampling models can inform the effects of pharmacological modulation on choice processes.
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Dauphin-Ducharme P, Yang K, Arroyo-Currás N, Ploense KL, Zhang Y, Gerson J, Kurnik M, Kippin TE, Stojanovic MN, Plaxco KW. Electrochemical Aptamer-Based Sensors for Improved Therapeutic Drug Monitoring and High-Precision, Feedback-Controlled Drug Delivery. ACS Sens 2019; 4:2832-2837. [PMID: 31556293 PMCID: PMC6886665 DOI: 10.1021/acssensors.9b01616] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The electrochemical aptamer-based (E-AB) sensing platform appears to be a convenient (rapid, single-step, and calibration-free) and modular approach to measure concentrations of specific molecules (irrespective of their chemical reactivity) directly in blood and even in situ in the living body. Given these attributes, the platform may thus provide significant opportunities to render therapeutic drug monitoring (the clinical practice in which dosing is adjusted in response to plasma drug measurements) as frequent and convenient as the measurement of blood sugar has become for diabetics. The ability to measure arbitrary molecules in the body in real time could even enable closed-loop feedback control over plasma drug levels in a manner analogous to the recently commercialized controlled blood sugar systems. As initial exploration of this, we describe here the selection of an aptamer against vancomycin, a narrow therapeutic window antibiotic for which therapeutic monitoring is a critical part of the standard of care, and its adaptation into an electrochemical aptamer-based (E-AB) sensor. Using this sensor, we then demonstrate: (i) rapid (seconds) and convenient (single-step and calibration-free) measurement of plasma vancomycin in finger-prick-scale samples of whole blood, (ii) high-precision measurement of subject-specific vancomycin pharmacokinetics (in a rat animal model), and (iii) high-precision, closed-loop feedback control over plasma levels of the drug (in a rat animal model). The ability to not only track (with continuous-glucose-monitor-like measurement frequency and convenience) but also actively control plasma drug levels provides an unprecedented route toward improving therapeutic drug monitoring and, more generally, the personalized, high-precision delivery of pharmacological interventions.
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Affiliation(s)
- Philippe Dauphin-Ducharme
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Kyungae Yang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Netzahualcóyotl Arroyo-Currás
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Kyle L. Ploense
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Yameng Zhang
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
| | - Julian Gerson
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Martin Kurnik
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Tod E. Kippin
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California 93106, United States
| | - Milan N. Stojanovic
- Center for Innovative Diagnostic and Therapeutic Approaches, Department of Medicine, Columbia University, New York, New York 10032, United States
- Department of Biomedical Engineering and Systems Biology, Columbia University, New York, New York 10032, United States
| | - Kevin W. Plaxco
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, California 93106, United States
- Center for Bioengineering, University of California, Santa Barbara, Santa Barbara, California 93106, United States
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Latuga NM, Gordon M, Farwell P, Farrell MO. A Cost and Quality Analysis of Utilizing a Rectal Catheter for Medication Administration in End-of-Life Symptom Management. J Pain Palliat Care Pharmacother 2018; 32:63-70. [PMID: 30596459 DOI: 10.1080/15360288.2018.1500509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Technology that can improve the ability to provide quick symptom control while decreasing the cost and burden of care could help hospice agencies deal with current hospice industry challenges. This paper describes how the use of a new rectal medication delivery technology at a large hospice in western New York has improved patient care and nursing efficiency while at the same time decreasing the cost of care.
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Abstract
Palliative sedation (PS) is performed in the terminally ill patient to manage one or more refractory symptoms. Proportional PS, which means that drugs can be titrated to the minimum effective dose, is the form most widely used. From a quarter to a third of all terminally ill patients undergo PS, with a quarter of these requiring continuous deep sedation. The prevalence of PS varies according to the care setting and case mix. The most frequent refractory physical symptoms are delirium and dyspnea, but PS is also considered for existential suffering or psychological distress, which is an extremely difficult and delicate issue to deal with. Active consensus from the patient and advanced care planning is recommended for PS. The decision-making process concerning the continuation or withdrawal of other treatments is not the same as that used for PS. The practice differs totally from euthanasia in its intentions, procedures, and results. The most widely used drugs are midazolam and haloperidol for refractory delirium, but chlorpromazine and other neuroleptics are also effective. In conclusion, some patients experience refractory symptoms during the last hours or days of life and PS is a medical intervention aimed at managing this unbearable suffering. It does not have a detrimental effect on survival.
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Affiliation(s)
| | | | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
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