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Report from the 2018 consensus conference on immunomodulating agents in thoracic transplantation: Access, formulations, generics, therapeutic drug monitoring, and special populations. J Heart Lung Transplant 2020; 39:1050-1069. [DOI: 10.1016/j.healun.2020.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 01/06/2023] Open
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Stanković DM, Kalcher K. The Immunosuppressive drug – Rapamycin – Electroanalytical Sensing Using Boron- Doped Diamond electrode. Electrochim Acta 2015. [DOI: 10.1016/j.electacta.2015.03.200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Holt DW, Mandelbrot DA, Tortorici MA, Korth-Bradley JM, Sierka D, Levy DI, See Tai S, Horowitz GL. Long-term evaluation of analytical methods used in sirolimus therapeutic drug monitoring. Clin Transplant 2014; 28:243-51. [PMID: 24476346 DOI: 10.1111/ctr.12305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/28/2022]
Abstract
Results of therapeutic monitoring of sirolimus blood concentrations are assay and laboratory dependent. This study compared performance over time of the IMx microparticle enzyme immunoassay (MEIA), Architect chemiluminescent microparticle immunoassay (CMIA), and liquid chromatography with mass spectrometric detection (LC/MS/MS) as part of a proficiency testing scheme. Pooled samples from sirolimus-treated patients and whole-blood samples spiked with known quantities of sirolimus were assayed monthly between 2004 and 2012. When results of pooled patient samples were compared with LC/MS/MS, the MEIA assay showed an overall mean percent bias of -2.3% ± 11.2% that, although initially positive, became increasingly negative from 2007 through 2009. The CMIA, which replaced the MEIA assay, had a mean percent bias of 21.9% ± 12.3%, remaining stable from 2007 through 2012. Similarly, for spiked samples, the MEIA showed an increasingly negative bias over time vs. LC/MS/MS, whereas CMIA maintained a stable positive bias. Based on comparison of immunoassay measurements on individual patient samples, CMIA values were more than 25% higher than MEIA values. These results highlight the importance of continued proficiency testing and regular monitoring of sirolimus assay performance. Clinicians must be aware of the methodology used and adjust target levels accordingly to avoid potential effects on efficacy and toxicity.
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Affiliation(s)
- David W Holt
- Analytical Services International, St. George's, University of London, London, UK
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Jourdil JF, Picard P, Meunier C, Auger S, Stanke-Labesque F. Ultra-fast cyclosporin A quantitation in whole blood by Laser Diode Thermal Desorption – Tandem Mass Spectrometry; comparison with High Performance Liquid Chromatography–Tandem Mass Spectrometry. Anal Chim Acta 2013; 805:80-6. [DOI: 10.1016/j.aca.2013.10.051] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/24/2013] [Accepted: 10/29/2013] [Indexed: 01/24/2023]
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Iranifam M. Analytical applications of chemiluminescence-detection systems assisted by magnetic microparticles and nanoparticles. Trends Analyt Chem 2013. [DOI: 10.1016/j.trac.2013.05.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Islambulchilar Z, Ghanbarzadeh S, Emami S, Valizadeh H, Zakeri-Milani P. Development and validation of an HPLC method for the analysis of sirolimus in drug products. Adv Pharm Bull 2012; 2:135-9. [PMID: 24312784 DOI: 10.5681/apb.2012.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 05/10/2012] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The aim of this study was to develop a simple, rapid and sensitive reverse phase high performance liquid chromatography (RP-HPLC) method for quantification of sirolimus (SRL) in pharmaceutical dosage forms. METHODS The chromatographic system employs isocratic elution using a Knauer- C18, 5 mm, 4.6 × 150 mm. Mobile phase consisting of acetonitril and ammonium acetate buffer set at flow rate 1.5 ml/min. The analyte was detected and quantified at 278nm using ultraviolet detector. The method was validated as per ICH guidelines. RESULTS The standard curve was found to have a linear relationship (r(2) > 0.99) over the analytical range of 125-2000ng/ml. For all quality control (QC) standards in intraday and interday assay, accuracy and precision range were -0.96 to 6.30 and 0.86 to 13.74 respectively, demonstrating the precision and accuracy over the analytical range. Samples were stable during preparation and analysis procedure. CONCLUSION Therefore the rapid and sensitive developed method can be used for the routine analysis of sirolimus such as dissolution and stability assays of pre- and post-marketed dosage forms.
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Affiliation(s)
- Ziba Islambulchilar
- Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran. ; Faculty of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran. ; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Hermida-Cadahia EF, Tutor JC. Determination of everolimus in blood samples from kidney and liver transplant recipients using the sirolimus chemiluminescence magnetic microparticle immunoassay (CMIA) on the Architect-i1000® System. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:180-3. [DOI: 10.3109/00365513.2011.646300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Immunosuppressive Drug Monitoring. Ther Drug Monit 2012. [DOI: 10.1016/b978-0-12-385467-4.00015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Evaluation of the Abbott ARCHITECT i2000 Sirolimus Assay and Comparison With the Abbott IMx Sirolimus Assay and an Established Liquid Chromatography–Tandem Mass Spectrometry Method. Ther Drug Monit 2011; 33:453-9. [DOI: 10.1097/ftd.0b013e3182263981] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Identification and elimination of ion suppression in the quantitative analysis of sirolimus in human blood by LC/ESI-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2011; 879:968-74. [PMID: 21435955 DOI: 10.1016/j.jchromb.2011.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/10/2011] [Accepted: 03/06/2011] [Indexed: 11/23/2022]
Abstract
Ion suppression can negatively affect the performance characteristics of LC/ESI-MS/MS based methods, and we wished to identify sources of ion suppression in an assay for quantitating sirolimus in human whole blood. We first compared the peak areas of sirolimus and ascomycin added to human blood samples treated with and without extraction using octadecyl silyl (ODS)-silica gel after protein precipitation, and we found that water-soluble compounds cause the ion suppression for both drugs. Post-column infusion studies indicated that compounds retained in the sample after ODS extraction and protein precipitation caused ion suppression. MS analysis of these compounds suggested they were hydroxyl group-possessing phosphocholines, and this was confirmed using purified lysophosphatidylcholine variants. Therefore, we included a HybridSPE treatment step after the ODS extraction into the preanalytical workflow to remove phosphocholines, and this successfully eliminated the observed ion suppression for determining sirolimus concentration in human whole blood by LC/ESI-MS/MS. Sirolimus is a highly lipophilic molecule, and this study demonstrates the impact that preanalytical extraction and purification steps can have on a laboratory's ability to accurately detect and quantitate this and other lipophilic drugs.
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Courtais C, Dupuy AM, Sophie Bargnoux A, Pageaux GP, Fegueux N, Mourad G, Cristol JP. Evaluation of two sirolimus assays using the ARCHITECT-i1000® CMIA or RxL® ACMIA methods in comparison with the IMx® MEIA method. Clin Chem Lab Med 2010; 48:1523-5. [DOI: 10.1515/cclm.2010.288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Multi-site analytical evaluation of a chemiluminescent magnetic microparticle immunoassay (CMIA) for sirolimus on the Abbott ARCHITECT analyzer. Clin Biochem 2009; 42:1543-8. [DOI: 10.1016/j.clinbiochem.2009.06.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/28/2009] [Accepted: 06/21/2009] [Indexed: 11/22/2022]
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Wang S, Miller A. A rapid liquid chromatography-tandem mass spectrometry analysis of whole blood sirolimus using turbulent flow technology for online extraction. Clin Chem Lab Med 2009; 46:1631-4. [PMID: 18842108 DOI: 10.1515/cclm.2008.303] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sirolimus is an immunosuppressant used in solid organ transplantation. Due to variable individual pharmacokinetics and narrow therapeutic ranges, therapeutic drug monitoring (TDM) is critical to the success of post-transplantation patient care. We developed a rapid method quantifying whole blood sirolimus using liquid chromatography-tandem mass spectrometry (LC-MS/MS) with an automated online extraction technology. METHODS Whole blood (100 microL) was mixed with a precipitation solution containing internal standard (32-desmethoxyrapamycin) and centrifuged at 15,634 x g for 10 min. The supernatant (50 microL) was injected onto a turbulent flow preparatory column and then a C18 analytical column. The mass spectrometer was set for positive electrospray to monitor the ammonium adducts. RESULTS Analytical time was 4 min/injection. Inter- and intra-assay variation coefficients across three concentration levels ranged from 2.3% to 7.4%. The method was linear from 1.0 to 100.0 ng/mL with an accuracy of 93.3%-100.0%. No carryover was detected from samples at 313.6 ng/mL. There was no obvious ion suppression from patient samples or interference from other commonly used immunosuppressants. Good correlation with an in-house commercial LC-MS was observed. CONCLUSIONS The LC-MS/MS method coupled with turbulent flow technology is rapid and efficient in TDM of whole blood sirolimus.
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Affiliation(s)
- Sihe Wang
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
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Filler G, Bendrick-Peart J, Strom T, Zhang YL, Johnson G, Christians U. Characterization of sirolimus metabolites in pediatric solid organ transplant recipients. Pediatr Transplant 2009; 13:44-53. [PMID: 18482220 DOI: 10.1111/j.1399-3046.2008.00956.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Potential age-dependent changes of sirolimus metabolite patterns in pediatric renal transplant recipients remain elusive. Thirteen pediatric solid organ transplant recipients (10 kidney, one combined liver-kidney, two liver, mean age 8.0 +/- 5.0 yr) underwent a sirolimus pharmacokinetic profile in steady-state with 10 samples drawn over 12 h post-intake to calculate the AUC(0-12 h). Concentrations of sirolimus and metabolite were quantified using a validated LC-MS/MS assay and metabolite structures were identified directly in blood extracts using LC-MS/iontrap. Average sirolimus AUC(0-12 h) was 64.9 +/- 29.7 ng h/mL. Median (range) AUC(0-12 h) for each metabolite (ng h/mL) was: 12-hydroxy-sirolimus 7.6 (0.2-18.8), 46-hydroxy sirolimus 3.1 (0.0-12.4), 24-hydroxy sirolimus 4.3 (0.0-12.6), piperidine-hydroxy sirolimus 3.5 (0.0-8.3), 39-O-desmethyl sirolimus 3.6 (0.0-11.3), 16-O-desmethyl sirolimus 5.0 (0.1-9.9), and di-hydroxy sirolimus 4.3 (0.0-32.5). The metabolites reached a median total AUC(0-12 h) of 60% of that of sirolimus. The range was 2.6-136%, indicating significant variability. In all, 77.5% of the metabolites were hydroxylated, while 39-O-desmethyl sirolimus accounted for only 8.4% of the AUC(0-12 h). This is clinically relevant as 39-O-desmethyl sirolimus shows 86-127% cross-reactivity with the antibody of the widely used Abbott sirolimus immunoassay. The metabolism of sirolimus in the children included in our study differed from that reported in adults, which should be considered when monitoring sirolimus exposure immunologically.
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Affiliation(s)
- Guido Filler
- Division of Nephrology, Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
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Bouzas L, Hermida J, Tutor JC. Determination of blood sirolimus concentrations in liver and kidney transplant recipients using the Innofluor fluorescence polarization immunoassay: comparison with the microparticle enzyme immunoassay and high-performance liquid chromatography-ultraviolet method. Ups J Med Sci 2009; 114:55-61. [PMID: 19242874 PMCID: PMC2852751 DOI: 10.1080/03009730802608254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although high-performance liquid chromatography (HPLC) is the method of choice for blood sirolimus determination, the microparticle enzyme immunoassay (MEIA) run on the IMx analyser is widely used in therapeutic monitoring of this immunosuppressant agent. The aim of our study was to evaluate the possible determination of sirolimus using the fluorescence polarization immunoassay (FPIA) commercialized for everolimus quantification. METHODS Sirolimus concentrations were determined in whole-blood samples from liver and kidney transplant recipients using the Innofluor Certican FPIA (Seradyn Inc.) run on a TDx analyser (Abbott Laboratories), Sirolimus MEIA run on an IMx analyser (Abbott Laboratories), and HPLC (UV detection) methods. RESULTS The Innofluor FPIA has a similar cross-reactivity with everolimus and sirolimus, and the within- and between-run coefficients of variation obtained for sirolimus determination were 2.7%-13.3%. In analysing different blood samples from liver and kidney transplant patients the linear regressions obtained were: FPIA = 1.12 HPLC + 0.43 (n=104, r=0.874), MEIA = 1.14 HPLC (n=146, r=0.892), and FPIA = 1.00 MEIA + 0.29 (n=106, r=0.941). Better correlation coefficients were obtained between the methods in the liver transplant samples (r>or=0.900) than in the kidney transplant samples (r>or=0.849). No significant effect was found for sirolimus clearance or the blood hematocrit on the relationship between the results produced by both immunoassays and HPLC. CONCLUSION The Innofluor FPIA is a valid alternative with an analogous performance to the MEIA for the therapeutic monitoring of sirolimus.
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Affiliation(s)
- Lorena Bouzas
- Unidad Monitorización Fármacos, Laboratorio Central, Hospital Clinico Universitario, Santiago de Compostela, Spain
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Abstract
This review summarizes the pharmacokinetics in children and youths of 2 commonly used immunosuppressive drugs, mycophenolate mofetil (MMF) and sirolimus (Sir), as presented at the IATDMCT 2007 conference. The review focuses on the developmental changes of drug disposition during childhood and adolescence. Regarding mycophenolate mofetil, the authors were unable to demonstrate age dependency of MMF in combination with cyclosporine. By contrast, there was an inverse relationship between age and the dose-normalized mycophenolate (MPA) area-under-the-time-concentration curve (AUC) in children who received concomitant tacrolimus (Tac). Dose-normalized MPA AUCs were higher than commonly observed in adult patients. It can be hypothesized that the age dependency is related to developmental changes in the expression of the UDP-glucuronosyltransferases. Sirolimus half-life and mean residence time (MRT) are shorter than in adults. Similar to that in adults, there is a profound drug-drug interaction between cyclosporine and Sir. In our own experience, Sir was started at 0.13 +/- 0.05 mg/kg/day. The average Sir AUC was 64.9 +/- 29.7 ng*h/mL. The median (range) AUC for each metabolite was as follows: 12-hydroxy-Sir, 7.6 (0.2-18.8); 46-hydroxy-Sir, 3.1 (0.0-12.4); 24-hydroxy-Sir, 4.3 (0.0-12.6); piperidine-hydroxy-Sir, 3.5 (0.0-8.3); 39-desmethyl-Sir, 3.6 (0.0-11.3); 16-desmethyl-Sir, 5.0 (0.1-9.9); and di-hydroxy-Sir, 4.3 (0.0-32.5) ng*h/mL. Of the total metabolite AUC, 77.5% was due to hydroxylated metabolites, while 39-O-desmethyl Sir (the main metabolite in adults) comprised only 8.4% of the metabolites. This is clinically relevant, as 39-O-desmethyl Sir shows 86% to 127% cross-reactivity with the Sir immunoassay. Metabolites reached a median AUC of 60% of that of Sir, but the range was 2.6% to 136%. The age dependency of Sir metabolite formation was confirmed in a human liver microsome model. On the basis of the age dependency of piperidine-hydroxy Sir, the authors postulate that the ontogeny of the drug disposition can be largely explained by developmental changes of the CYP2C8 expression. In conclusion, both Sir and MMF drug disposition vary in children and adolescents from adult patients, most likely because of developmental changes of biliary transporters and metabolic enzymes.
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Pieri M, Miraglia N, Gentile A, Polichetti G, Castiglia L, Federico S, Sabbatini M, Basile V, Tarantino G, Acampora A, Capone D. Quantification of sirolimus and everolimus by immunoassay techniques: test specificity and cross-reactivity evaluation. Int J Immunopathol Pharmacol 2008; 21:585-94. [PMID: 18831925 DOI: 10.1177/039463200802100311] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The possible cross-reactivity of immunoassays with structurally-related drugs was investigated. Innofluor Certican (FPIA) calibrators were measured by using IMx Sirolimus assay (MEIA) and MEIA Sirolimus calibrators were analysed by using FPIA Certican assay. Drug concentrations were measured in 95 and 100 samples from renal transplanted patients (RTP) on sirolimus or everolimus treatment by using immunoassays and LC/ESI-MSMS. A high cross-reactivity was found both for MEIA and FPIA. High correlation degrees, confirmed by the Bland-Altman and the Eksborg tests, were found between drug concentrations measured in real samples by both immunoassays (r = 0.909 and r = 0.970, respectively). LC/ESI-MSMS analysis of samples containing sirolimus showed no positivity for everolimus. Similarly, samples from patients on treatment with everolimus resulted negative as far as regards sirolimus. MEIA and FPIA could be considered mutually reliable and accurate alternatives for the specific-drug immunoassay. It should be noticed that in patients switching from one drug to the other unreal overestimation of the blood levels of the current administered immunosuppressant can occur.
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Affiliation(s)
- M Pieri
- Department of Public Medicine and Social Health, University Federico II of Naples, Naples, Italy
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Recent development in application of high performance liquid chromatography-tandem mass spectrometry in therapeutic drug monitoring of immunosuppressants. J Immunol Methods 2008; 336:98-103. [DOI: 10.1016/j.jim.2008.05.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 04/28/2008] [Accepted: 05/01/2008] [Indexed: 11/22/2022]
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Ansermot N, Fathi M, Veuthey JL, Desmeules J, Rudaz S, Hochstrasser D. Simultaneous quantification of cyclosporine, tacrolimus, sirolimus and everolimus in whole blood by liquid chromatography–electrospray mass spectrometry. Clin Biochem 2008; 41:728-35. [DOI: 10.1016/j.clinbiochem.2008.02.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 02/15/2008] [Accepted: 02/26/2008] [Indexed: 10/22/2022]
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Colantonio DA, Borden KK, Clarke W. Comparison of the CEDIA® and MEIA® assays for the measurement of sirolimus in organ transplant recipients. Clin Biochem 2007; 40:680-7. [PMID: 17428457 DOI: 10.1016/j.clinbiochem.2007.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 01/25/2007] [Accepted: 02/11/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study evaluated two immunoassays, the CEDIA assay and the MEIA assay, used for the measurement of whole blood levels of sirolimus in organ transplant recipients. DESIGN AND METHODS We report on the performance characteristics (total precision, limit of quantitation (functional sensitivity), limit of detection (analytical sensitivity), linearity, accuracy) for each assay. Patient correlation studies were performed, and the results were analyzed using Bland-Altman plots and Passing-Bablok analysis. RESULTS Total precision for the MEIA assay, corresponding to three mean concentrations of 5.0, 10.6 and 20.2 ng/mL, was 10.5, 8.5, and 6.7%, respectively. The limit of detection was determined to be 1.1 ng/mL and the limit of quantitation was 1.5 ng/mL. The mean recovery for CEDIA was 105.4%, and analysis of proficiency material demonstrated a large negative bias with respect to the mass spectrometry peer mean-later determined to be due to matrix interference. Results for the CEDIA assay showed a total precision, corresponding to a mean concentration of 5.4, 10.5 and 20.7 ng/mL, of 13.5, 5.6, and 4.1%, respectively. The limit of detection was found to be 4.8 ng/mL, with a limit of quantitation of 5.2 ng/mL. The mean recovery for MEIA was 110.1%, and analysis of proficiency material demonstrated good agreement with the mass spectrometry peer mean with a slight positive bias. Both assays were acceptably linear over the reportable range of the assay. Patient correlation studies demonstrated a positive average bias for both assays versus results from LC-MS measurement (0.9 ng/mL for MEIA, 2.1 ng/mL for CEDIA). CONCLUSION Based on this evaluation, the MEIA demonstrated acceptable performance for use in clinical monitoring of sirolimus. However, based on a higher limit of quantitation that falls within the therapeutic interval, the CEDIA is not recommended for clinical monitoring of sirolimus.
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Affiliation(s)
- David A Colantonio
- Johns Hopkins University School of Medicine, Baltimore, MD 21287-7065, USA
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Bogusz MJ, Enazi EA, Hassan H, Abdel-Jawaad J, Ruwaily JA, Tufail MA. Simultaneous LC–MS–MS determination of cyclosporine A, tacrolimus, and sirolimus in whole blood as well as mycophenolic acid in plasma using common pretreatment procedure. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 850:471-80. [PMID: 17239667 DOI: 10.1016/j.jchromb.2006.12.048] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2006] [Revised: 12/16/2006] [Accepted: 12/18/2006] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to develop rapid and simple procedure for simultaneous determination of cyclosporine A (CsA), tacrolimus (TCR), and sirolimus (SIR) in whole blood and mycophenolic acid (MPA) in plasma. Ascomycin (ASCO), cyclosporine D (CsD), and desmethoxysirolimus (DMSIR) were used as internal standards (IS) for TCR, CsA and MPA, and SIR, respectively. In the method development, six-level blood calibrators were used for CsA (range 47-1725 ng/ml), TCR (range 2.1-38.8 ng/ml), and SIR (range 2.4-39.6 ng/ml). Four-level calibrators were used for MPA (range 0.15-5.48 microg/ml). Four levels of quality control (QC) standards were used for blood samples, together with two levels of QC standards in plasma. All QC standards and calibrators were obtained from commercial sources. Sample preparation based on precipitation of 50 microl of sample in zinc sulfate-methanol-acetonitrile mixture containing IS, followed by centrifugation. HPLC was performed on ChromSpher pi column, 30 mm x 3 mm, in ballistic gradient of ammonium formate buffer-methanol at 0.8 ml flow rate. Following gradient elution profile was applied: 0-1.2 min at 30% methanol (divert valve to waste), 1.21-3.1 min 97% methanol (divert valve to detector), 3.11-3.7 min 30% methanol (divert valve to waste). ESI-MS-MS (MRM) was done on TSQ Quantum instrument with ESI source in positive ion mode. Ammoniated adducts of protonated molecules were used as precursor ions for all analytes but MPA. For this compound sodium adduct was used. Following transitions were monitored: for CsA m/z 1220-1203; for CsD 1234-1217; for SIR 931.6-864.5 and 882.6; for DMSIR 902-834.5; for TCR 821.5-768.5 and 785.5; for ASCO 809.5-756; for MPA 343-211.6; for MPA-glucuronide 514-306 and 211.6. The limits of quantitation were: 1 ng/ml for TCR and SIR, 20 ng/ml for CsA, and 0.1 microg/ml for MPA. Post-column infusion experiments showed that no positive or negative peaks appeared after injection of matrix in the elution range of target compounds. General signal suppression caused by matrix ranged from 20-40%, and was caused mainly by zinc sulfate present in deproteinizing solution. Extracted samples were stable for 2 days at 4 degrees C and for at least 20 days at -20 degrees C. MPA was fully separated from its glucuronide, which was eluted at around 0.7-0.8 min and directed to the waste. Some mutual cross-contribution of CsD and CsA was observed (below 1%), other IS did not contribute to target compounds and vice versa. Observations of chromatograms from patients taken single therapy demonstrated that possible metabolites of CsA, TCR, or SIR did not interfere with target compounds or IS.
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Affiliation(s)
- Maciej J Bogusz
- King Faisal Specialist Hospital and Research Centre, 11211 Riyadh, Saudi Arabia.
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Bouzas L, Tutor JC. Determination of everolimus in whole blood using the Abbott IMx® sirolimus microparticle enzyme immunoassay. Clin Biochem 2007; 40:132-6. [PMID: 17011541 DOI: 10.1016/j.clinbiochem.2006.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 08/10/2006] [Accepted: 08/16/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Everolimus (Certican) is a new immunosuppressant derived from sirolimus (Rapamune) with a 2-hydroxyethyl chain at position 40 of the macrolide ring. The aim of our study was to evaluate the possible determination of everolimus in whole blood using a commercialized microparticle enzyme immunoassay for sirolimus determination. DESIGN AND METHODS Everolimus concentrations were determined in blood samples from 11 kidney transplant patients (n=51) and different control materials (n=35) using the Seradyn Innofluor Certican fluorescence polarization immunoassay (FPIA) and the Abbott IMx sirolimus microparticle enzyme immunoassay (MEIA). RESULTS The MEIA gave a concentration-dependent cross-reactivity with the everolimus, with a linear regression between the assigned values (y) for the Innofluor Certican calibrators and those obtained (x) using this immunoassay: y=0.96x+0.67 (ma68=0.21 microg/L, r=0.974, p<0.001). The within- and between-run coefficients of variation using the MEIA were <or=7.3%. In analyzing the different blood samples from patients and control materials using the MEIA and FPIA, a linear regression was found: MEIA=0.99FPIA-0.46 (ma68=0.32 microg/L, r=0.967, p<0.001). Correcting the MEIA results by means of the linear regression equation found between the assigned values for the Innofluor Certican calibrators and those obtained using this immunoassay led to a reduction in the deviation with respect to the FPIA values. The possible effect of the hematocrit on the results is analogous for both immunoassays. CONCLUSIONS The Abbott IMx sirolimus MEIA permits the simple and precise determination of everolimus in whole blood, making it a valid alternative for the therapeutic monitoring of this immunosuppressant agent.
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Affiliation(s)
- Lorena Bouzas
- Unidad Monitorización Fármacos, Laboratorio Central, Hospital Clínico Universitario, Santiago de Compostela, Spain
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Oellerich M, Armstrong VW. The Role of Therapeutic Drug Monitoring in Individualizing Immunosuppressive Drug Therapy: Recent Developments. Ther Drug Monit 2006; 28:720-5. [PMID: 17164686 DOI: 10.1097/ftd.0b013e31802c5cf5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Oellerich
- Abteilung Klinische Chemie, Georg-August-University Göttingen, Germany.
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Baldelli S, Crippa A, Gabrieli R, Fiocchi R, Perico N, Merlini S, Ottomano C, Cattaneo D. Comparison of the Innofluor certican assay with HPLC-UV for the determination of everolimus concentrations in heart transplantation. Clin Biochem 2006; 39:1152-9. [PMID: 17054930 DOI: 10.1016/j.clinbiochem.2006.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 04/28/2006] [Accepted: 08/29/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Therapeutic monitoring of everolimus with chromatographic methods (HPLC) enabled effective immunosuppression while limiting the incidence of drug-related adverse events. A fluorescence polarization immunoassay (FPIA) has been recently developed for the assessment of everolimus levels. The present study was designed to evaluate FPIA performance and to compare it to HPLC. DESIGN AND METHODS The performance of HPLC and FPIA was initially tested using drug-free whole blood spiked with different amount of everolimus concentrations and, subsequently, by analyzing 113 trough blood samples from heart transplant recipients chronically given everolimus as part of their immunosuppressive regimen. RESULTS Inaccuracy and imprecision of both methods were below 15%. The correlation between everolimus concentrations and measured FPIA and HPLC was good, with a Pearson coefficient of 0.9118. The FPIA gave a mean overestimation of 24.3% as compared with HPLC. As additional analysis, cross-reactivity ranging from 85.4% to 138.0% was found with sirolimus, an immunosuppressant with a chemical structure close to everolimus. CONCLUSION The FPIA demonstrated acceptable performance for therapeutic drug monitoring of everolimus, and is a viable alternative to HPLC-based methods.
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Affiliation(s)
- Sara Baldelli
- Department of Medicine and Transplantation, Ospedali Riuniti di Bergamo-Mario Negri Institute for Pharmacological Research, Bergamo, Italy
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