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Piolatto A, Gaglioti CM, Tesio N, Clemente MG, Culcasi M, Matrone A, Pila MP, Sambataro A, Longo F, Origa R, Ferrero GB. Deferasirox film-coated tablet-associated ulcerative colitis: An emerging pattern in thalassemia patients? Br J Haematol 2024; 205:719-721. [PMID: 38782586 DOI: 10.1111/bjh.19558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Andrea Piolatto
- Department of Clinical and Biological Sciences, Reference Centre for Haemoglobinopathies, San Luigi Gonzaga University Hospital, University of Torino, Orbassano, Italy
| | - Carmen Maria Gaglioti
- Department of Clinical and Biological Sciences, Reference Centre for Haemoglobinopathies, San Luigi Gonzaga University Hospital, University of Torino, Orbassano, Italy
| | - Nicolò Tesio
- Department of Clinical and Biological Sciences, Reference Centre for Haemoglobinopathies, San Luigi Gonzaga University Hospital, University of Torino, Orbassano, Italy
| | - Maria Grazia Clemente
- S.S.D. Thalassemia, Department of Medical Sciences and Public Health, "Antonio Cao" Children Hospital, University of Cagliari, Cagliari, Italy
| | - Martina Culcasi
- S.S.D. Thalassemia and Hemoglobinopathies, A.O.U. Arcispedale Sant'Anna di Ferrara, Cona, Italy
| | - Alessio Matrone
- Department of Clinical and Biological Sciences, Reference Centre for Haemoglobinopathies, San Luigi Gonzaga University Hospital, University of Torino, Orbassano, Italy
| | - Maria Paola Pila
- S.S.D. Thalassemia, Department of Medical Sciences and Public Health, "Antonio Cao" Children Hospital, University of Cagliari, Cagliari, Italy
| | - Angela Sambataro
- Gastroenterology Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Filomena Longo
- S.S.D. Thalassemia and Hemoglobinopathies, A.O.U. Arcispedale Sant'Anna di Ferrara, Cona, Italy
| | - Raffaella Origa
- S.S.D. Thalassemia, Department of Medical Sciences and Public Health, "Antonio Cao" Children Hospital, University of Cagliari, Cagliari, Italy
| | - Giovanni Battista Ferrero
- Department of Clinical and Biological Sciences, Reference Centre for Haemoglobinopathies, San Luigi Gonzaga University Hospital, University of Torino, Orbassano, Italy
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Kabil MF, Nasr M. Deferasirox: A comprehensive drug profile. PROFILES OF DRUG SUBSTANCES, EXCIPIENTS, AND RELATED METHODOLOGY 2024; 49:1-18. [PMID: 38423705 DOI: 10.1016/bs.podrm.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Deferasirox is an iron-chelating drug developed by Novartis company for treatment of diseases accompanied by chronic iron overload; such as β-thalassemia or sickle cell diseases. Owing to its advantages such as high affinity, specificity and wide therapeutic window, it is considered as first line treatment. The current chapter describes the physicochemical characteristics, mode of action, pharmacokinetics, therapeutic applications and synthetic methods for deferasirox. Moreover, it includes Fourier transform infrared spectrometry (FTIR) and nuclear magnetic resonance spectroscopy (NMR) analysis for its functional groups. In addition, the selected analytical methods are summarized to aid the analysts in their routine analysis of deferasirox.
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Affiliation(s)
- Mohamed Fawzi Kabil
- Nanoscience Program, University of Science and Technology (UST), Zewail City of Science and Technology, Giza, Egypt
| | - Maha Nasr
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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Fares MY, Hegazy MA, El-Sayed GM, Abdelrahman MM, Abdelwahab NS. Quality by design approach for green HPLC method development for simultaneous analysis of two thalassemia drugs in biological fluid with pharmacokinetic study. RSC Adv 2022; 12:13896-13916. [PMID: 35548387 PMCID: PMC9084420 DOI: 10.1039/d2ra00966h] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 01/01/2023] Open
Abstract
This work implements a combined experimental approach of analytical quality-by-design (AQbD) and green analytical chemistry (GAC) to develop an HPLC method for simultaneous determination of the two thalassemia drugs, deferasirox (DFX) and deferiprone (DFP), in biological fluid for the first time. This integration was designed to maximize efficiency and minimize environmental impacts, as well as energy and solvent consumption. To accomplish this goal, an analytical quality-by-design approach was performed, beginning with quality risk assessment and scouting analysis, followed by Placket-Burman design screening for five chromatographic parameters. Critical method parameters were thoroughly recognized and then optimized by using a two levels-three factors custom experimental design to evaluate the optimum conditions that achieved the highest resolution with acceptable peak symmetry within the shortest run time. The desirability function was used to define the optimal chromatographic conditions, and the optimal separation was achieved using an XBridge® HPLC RP-C18 (4.6 × 250 mm, 5 μm) column with ethanol : acidic water at pH 3.0 adjusted by phosphoric acid in the ratio of (70 : 30, v/v) as the mobile phase at a flow rate of 1 mL min-1 with UV detection at 225 nm at a temperature of 25 °C. Linearity was obtained over the concentration range of 0.30-20.00 μg mL-1 and 0.20-20.00 μg mL-1 for DFX and DFP, respectively, using 20.00 μg mL-1 ibuprofen (IBF) as an internal standard. The established method's greenness profile was evaluated and measured using various assessment tools, and the developed method was green. For the validation of the developed method, FDA recommendations were followed, and all the results obtained met the acceptance criteria. The suggested method was successfully used to study the pharmacokinetic parameters of DFX and DFP in rat plasma. Due to the substantial increase in bioavailability of the two iron chelating drugs, the results from this study strongly recommend their co-administration.
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Affiliation(s)
- Michel Y Fares
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Nahda University Sharq El-Nile 62511 Beni-Suef Egypt
| | - Maha A Hegazy
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University Kasr El-Aini Street Cairo 11562 Egypt +20-100-548-6038
| | - Ghada M El-Sayed
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University Kasr El-Aini Street Cairo 11562 Egypt +20-100-548-6038
| | - Maha M Abdelrahman
- Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Beni-Suef University Alshaheed Shehata Ahmad Hegazy St 62514 Beni-Suef Egypt
| | - Nada S Abdelwahab
- Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Beni-Suef University Alshaheed Shehata Ahmad Hegazy St 62514 Beni-Suef Egypt
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Lin HJ, Wang CC, Kou HS, Cheng CW, Wu SM. Stable Luminescent Poly(Allylaminehydrochloride)-Templated Copper Nanoclusters for Selectively Turn-Off Sensing of Deferasirox in β-Thalassemia Plasma. Pharmaceuticals (Basel) 2021; 14:1314. [PMID: 34959714 PMCID: PMC8706525 DOI: 10.3390/ph14121314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 01/19/2023] Open
Abstract
Highly stable and facile one-pot copper nanoclusters (Cu NCs) coated with poly(allylamine hydrochloride) (PAH) have been synthesized for selectively sensing deferasirox (DFX) in β-thalassemia plasma. DFX is an important drug used for treating iron overloading in β-thalassemia, but needs to be monitored due to certain toxicity. In this study, the PAH-Cu NCs showed highly stable fluorescence with emission wavelengths at 450 nm. The DFX specifically interacted with the copper nanocluster to turn off the fluorescence of the PAH-Cu NCs, and could be selectively quantified through the fluorescence quenching effect. The linear range of DFX in plasma analyzed by PAH-Cu NCs was 1.0-100.0 µg/mL (r = 0.985). The relative standard deviation (RSD) and relative error (RE) were lower than 6.51% and 7.57%, respectively, showing excellent reproducibility of PAH-Cu NCs for sensing DFX in plasma. This method was also successfully applied for an analysis of three clinical plasma samples from β-thalassemia patients taking DFX. The data presented high similarity with that obtained through a capillary electrophoresis method. According to the results, the PAH-Cu NCs could be used as a tool for clinically sensing DFX in human plasma for clinical surveys.
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Affiliation(s)
- Hung-Ju Lin
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-J.L.); (H.-S.K.); (C.-W.C.)
| | - Chun-Chi Wang
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-J.L.); (H.-S.K.); (C.-W.C.)
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Hwang-Shang Kou
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-J.L.); (H.-S.K.); (C.-W.C.)
| | - Cheng-Wei Cheng
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (H.-J.L.); (H.-S.K.); (C.-W.C.)
| | - Shou-Mei Wu
- Department of Fragrance and Cosmetic Science, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Taiwan Food and Drug Administration, Ministry of Health and Welfare, Taipei 11561, Taiwan
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5
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Pharmacological and clinical evaluation of deferasirox formulations for treatment tailoring. Sci Rep 2021; 11:12581. [PMID: 34131221 PMCID: PMC8206201 DOI: 10.1038/s41598-021-91983-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/20/2021] [Indexed: 01/19/2023] Open
Abstract
Deferasirox (DFX) is the newest among three different chelators available to treat iron overload in iron-loading anaemias, firstly released as Dispersible Tablets (DT) and more recently replaced by Film-Coated Tablets (FCT). In this retrospective observational study, pharmacokinetics, pharmacodynamics, and safety features of DFX treatment were analyzed in 74 patients that took both formulations subsequently under clinical practice conditions. Bioavailability of DFX FCT compared to DT resulted higher than expected [Cmax: 99.5 (FCT) and 69.7 (DT) μMol/L; AUC: 1278 (FCT) and 846 (DT), P < 0.0001]. DFX FCT was also superior in scalability among doses. After one year of treatment for each formulation, no differences were observed between the treatments in the overall iron overload levels; however, DFX FCT but not DT showed a significant dose–response correlation [Spearman r (dose-serum ferritin variation): − 0.54, P < 0.0001]. Despite being administered at different dosages, the long-term safety profile was not different between formulations: a significant increase in renal impairment risk was observed for both treatments and it was reversible under strict monitoring (P < 0.002). Altogether, these data constitute a comprehensive comparison of DFX formulations in thalassaemia and other iron-loading anaemias, confirming the effectiveness and safety characteristics of DFX and its applicability for treatment tailoring.
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Golpayegani MR, Akramipour R, Fattahi N. Sensitive determination of deferasirox in blood of patients with thalassemia using dispersive liquid-liquid microextraction based on solidification of floating organic drop followed by HPLC-UV. J Pharm Biomed Anal 2020; 193:113735. [PMID: 33202348 DOI: 10.1016/j.jpba.2020.113735] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 01/19/2023]
Abstract
Deferasirox is an oral iron chelator that has been on the market since 2005 and has been a suitable replacement for injectable chelators. It is important to check the amount of this drug in the blood of patients due to side effects. In this study, a new dispersive liquid-liquid microextraction based on solidification of floating drganic drop (DLLME - SFO) was applied to the extraction of deferasirox in the blood of patients with thalassemia prior to its analysis by high-performance liquid chromatography-ultraviolet detection (HPLC - UV). In this method, two long alcohols of the normal chain are mixed in a particular ratio, and then it is injected into the sample solution, which is on the magnetic stirrer. In this case, the mixture of the two alcohol changes to new double-solvent aggregate. This new double-solvent system is used as an extractant, which has a higher extraction power than any of its components alone. Under the optimum conditions, the calibration graph was linear in the rage of 0.2-200 μg L-1 with detection limit of 0.06 μg L-1. Repeatability (intra-day) and reproducibility (inter-day) of method based on seven replicate measurements of 100.0 μg L-1of deferasirox were 3.8 % and 5.7 %, respectively. The results showed that DLLME - SFO is a very simple, inexpensive, environmental friendly, sensitive and efficient analytical method for the determination of trace amount of drugs in biological samples and suitable results were obtained.
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Affiliation(s)
- Mohammad Reza Golpayegani
- School of Medical, Kermanshah University of Medical Sciences, Kermanshah, Iran; Clinical Research Development Center, Mohammad Kermanshahi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Akramipour
- School of Medical, Kermanshah University of Medical Sciences, Kermanshah, Iran; Clinical Research Development Center, Mohammad Kermanshahi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazir Fattahi
- Research Center for Environmental Determinants of Health (RCEDH), Health Inestitue, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Onal C, Tekkeli SEK, Sagiroglu AA. A Liquid Chromatographic Analysis of Deferasirox in Human Breast Milk with Fluorimetric Detection. Chromatographia 2020. [DOI: 10.1007/s10337-020-03953-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Tuzimski T, Petruczynik A. Review of Chromatographic Methods Coupled with Modern Detection Techniques Applied in the Therapeutic Drugs Monitoring (TDM). Molecules 2020; 25:E4026. [PMID: 32899296 PMCID: PMC7504794 DOI: 10.3390/molecules25174026] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/29/2020] [Accepted: 08/30/2020] [Indexed: 12/15/2022] Open
Abstract
Therapeutic drug monitoring (TDM) is a tool used to integrate pharmacokinetic and pharmacodynamics knowledge to optimize and personalize various drug therapies. The optimization of drug dosing may improve treatment outcomes, reduce toxicity, and reduce the risk of developing drug resistance. To adequately implement TDM, accurate and precise analytical procedures are required. In clinical practice, blood is the most commonly used matrix for TDM; however, less invasive samples, such as dried blood spots or non-invasive saliva samples, are increasingly being used. The choice of sample preparation method, type of column packing, mobile phase composition, and detection method is important to ensure accurate drug measurement and to avoid interference from matrix effects and drug metabolites. Most of the reported procedures used liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) techniques due to its high selectivity and sensitivity. High-performance chromatography with ultraviolet detection (HPLC-UV) methods are also used when a simpler and more cost-effective methodology is desired for clinical monitoring. The application of high-performance chromatography with fluorescence detection (HPLC-FLD) with and without derivatization processes and high-performance chromatography with electrochemical detection (HPLC-ED) techniques for the analysis of various drugs in biological samples for TDM have been described less often. Before chromatographic analysis, samples were pretreated by various procedures-most often by protein precipitation, liquid-liquid extraction, and solid-phase extraction, rarely by microextraction by packed sorbent, dispersive liquid-liquid microextraction. The aim of this article is to review the recent literature (2010-2020) regarding the use of liquid chromatography with various detection techniques for TDM.
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Affiliation(s)
- Tomasz Tuzimski
- Department of Physical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
| | - Anna Petruczynik
- Department of Inorganic Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland
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Malik A, Firke SD, Patil RR, Shirkhedkar AA, Surana SJ. Determination of Iron Chelating Agents by Analytical Methods: A Review. Crit Rev Anal Chem 2019; 50:254-264. [PMID: 31140834 DOI: 10.1080/10408347.2019.1620095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute iron poisoning and chronic iron overload consequences in significant morbidity and mortality worldwide. Treatment of acute iron poisoning and chronic iron overload can be challenging and care providers are often tackled with management dilemmas. Iron chelating agents are commonly prescribed for patients with iron deficiency anemia. In this review article, different analytical techniques are reported used for qualitative and quantitative analysis of iron chelating agents like, deferiprone, deferoxamine, and deferasirox. Efforts are taken to collect all related articles published till October 2018. This review discusses all analytical methods, its advantages and disadvantages as well as its applications. This article will help you to know about basic analytical techniques as well as advanced hyphenated techniques practiced for determination of iron chelating agents in different matrices. The techniques discussed in this review follow the ICH guidelines for method validation.
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Affiliation(s)
- Aamir Malik
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Sandip D Firke
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Ravindra R Patil
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Atul A Shirkhedkar
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
| | - Sanjay J Surana
- Department of Pharmaceutical Chemistry, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, India
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Role of CYP1A1, ABCG2, CYP24A1 and VDR gene polymorphisms on the evaluation of cardiac iron overload in thalassaemia patients. Pharmacogenet Genomics 2019; 28:199-206. [PMID: 30179981 DOI: 10.1097/fpc.0000000000000348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Iron-burden-induced arrhythmia and heart failure are among the leading causes of morbidity and mortality in β-thalassaemia major patients. T2* cardiac magnetic resonance remains the only reliable noninvasive method for the heart iron excess assessment. We explored the role of single nucleotide polymorphisms involved in vitamin D metabolism, transport and activity and in deferasirox (DFX) metabolism on cardiac iron burden. PATIENTS AND METHODS One hundred and five β-thalassaemia patients, treated with DFX, were enrolled in the present study. Drug plasma Ctrough was measured by a high-performance liquid chromatography-ultraviolet method. Allelic discrimination was carried out using the real-time PCR. RESULTS CYP1A1*1189 CC, ABCG2 421 GA, CYP24A1 8620 GG and VDR TaqI CC single nucleotide polymorphisms influenced T2* values. Age, serum ferritin, ABCG2 421 GA, ABCG2 1194 +928 TC/CC, CYP24A1 22776 TT and VDR TaqI TC/CC were retained in linear regression model. CONCLUSION Our results suggested, for the first time, the role of DFX and vitamin D pharmacogenetics on cardiac iron overload.
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The effect of vitamin D pathway genes and deferasirox pharmacogenetics on liver iron in thalassaemia major patients. THE PHARMACOGENOMICS JOURNAL 2019; 19:417-427. [PMID: 30651574 DOI: 10.1038/s41397-019-0071-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/01/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023]
Abstract
Monitoring and treating iron overload is crucial in transfusion-dependent thalassaemia patients. Liver stiffness measurement by transient elastography and T2* magnetic resonance imaging represent non-invasive ways to evaluate the adequacy of the iron chelation treatment. We explored the role of single nucleotide polymorphisms involved in vitamin D metabolism, transport and activity, and in deferasirox metabolism on liver iron burden parameters. One-hundred and five beta-thalassaemia patients, treated with deferasirox, have been enrolled. Drug plasma Ctrough and AUC were measured by a HPLC-UV method. Allelic discrimination was performed by real-time PCR. Age, UGT1A1-364 CT/TT and CYP27B1 -1260 GT/TT positively predicted liver stiffness values. Deferasirox dose and serum ferritin negatively predicted T2* data, whereas age and CYP2D6 1457 GG genotype positively influenced these values. The discoveries of this research may be useful for personalized medicine and the proposed method could be applied in patients with hereditary hemochromatosis and myelodysplastic syndromes.
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van Raaij SEG, Rennings AJ, Biemond BJ, Schols SEM, Wiegerinck ETG, Roelofs HMJ, Hoorn EJ, Walsh SB, Nijenhuis T, Swinkels DW, van Swelm RPL. Iron handling by the human kidney: glomerular filtration and tubular reabsorption both contribute to urinary iron excretion. Am J Physiol Renal Physiol 2019; 316:F606-F614. [PMID: 30623722 DOI: 10.1152/ajprenal.00425.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In physiological conditions, circulating iron can be filtered by the glomerulus and is almost completely reabsorbed by the tubular epithelium to prevent urinary iron wasting. Increased urinary iron concentrations have been associated with renal injury. However, it is not clear whether increased urinary iron concentrations in patients are the result of increased glomerular iron filtration and/or insufficient tubular iron reabsorption and if these processes contribute to renal injury. We measured plasma and urine iron parameters and urinary tubular injury markers in healthy human subjects ( n = 20), patients with systemic iron overload ( n = 20), and patients with renal tubular dysfunction ( n = 18). Urinary iron excretion parameters were increased in both patients with systemic iron overload and tubular dysfunction, whereas plasma iron parameters were only increased in patients with systemic iron overload. In patients with systemic iron overload, increased urinary iron levels were associated with elevated circulating iron, as indicated by transferrin saturation (TSAT), and increased body iron, as suggested by plasma ferritin concentrations. In patients with tubular dysfunction, enhanced urinary iron and transferrin excretion were associated with distal tubular injury as indicated by increased urinary glutathione S-transferase pi 1-1 (GSTP1-1) excretion. In systemic iron overload, elevated urinary iron and transferrin levels were associated with increased injury to proximal tubules, indicated by increased urinary kidney injury marker 1 (KIM-1) excretion. Our explorative study demonstrates that both glomerular filtration of elevated plasma iron levels and insufficient tubular iron reabsorption could increase urinary iron excretion and cause renal injury.
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Affiliation(s)
- Sanne E G van Raaij
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Alexander J Rennings
- Department of Internal Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Bart J Biemond
- Department of Hematology, Academic Medical Center , Amsterdam , The Netherlands
| | - Saskia E M Schols
- Department of Hematology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Erwin T G Wiegerinck
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hennie M J Roelofs
- Department of Gastroenterology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Stephen B Walsh
- University College London Centre for Nephrology , London , United Kingdom
| | - Tom Nijenhuis
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Rachel P L van Swelm
- Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
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Effect of pharmacogenetic markers of vitamin D pathway on deferasirox pharmacokinetics in children. Pharmacogenet Genomics 2018; 28:17-22. [PMID: 29099735 DOI: 10.1097/fpc.0000000000000315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Patients with β-thalassemia major have extremely low vitamin D levels, owing to reduced intestinal absorption, subicteric tint, and/or iron-induced higher pigmentation. We investigated whether some polymorphisms within the VDR, CYP24A1, CYP27B1, and GC genes could play a role in deferasirox pharmacokinetics in a cohort of pediatric patients. PATIENTS AND METHODS Eighteen children with β-thalassemia were enrolled. Drug plasma concentrations at the end of dosing interval (Ctrough) and after 0, 2, 4, 6, and 24 h of drug administration were measured by a HPLC-UV method. Allelic discrimination for VDR (TaqI, FokI, BsmI, Cdx2, and ApaI), CYP24A1 (22776, 3999 and 8620), CYP27B1 (2838 and -1260), and GC (1296) single nucleotide polymorphisms was performed by real-time PCR. RESULTS CYP24A1 8620 AG/GG group negatively predicted Ctrough in regression analysis (P=0.012). ApaI AA genotype resulted as a negative predictor of Ctrough (P=0.025) and area under the concentration curve (P=0.007); FoKI CC genotype remained as area under the concentration curve positive predictor (P=0.008) and TC/CC group as half-life (t1/2) (P=0.003) and volume of distribution (Vd) (P=0.011) negative one; TaqI TC/CC was retained as a negative predictor of drug maximum concentration (Cmax) (P=0.004). Moreover, GC 1296 TG/GG seemed able to predict lower time to reach drug maximum concentration (Tmax) (P=0.033). CONCLUSION Our preliminary experience suggested the potential usefulness of vitamin D pharmacogenetic to better understand deferasirox interindividual variability, also in pediatric patients.
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Allegra S, Massano D, De Francia S, Longo F, Piccione F, Pirro E, Cusato J, D'Avolio A, Piga A. Clinical relevance of deferasirox trough levels in β-thalassemia patients. Clin Exp Pharmacol Physiol 2017; 45:213-216. [DOI: 10.1111/1440-1681.12879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Sarah Allegra
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin Italy
| | - Davide Massano
- Department of Paediatrics; Centre for Microcitemie; University of Turin; S. Luigi Gonzaga Hospital; Orbassano Italy
| | - Silvia De Francia
- Department of Biological and Clinical Sciences; University of Turin; S. Luigi Gonzaga Hospital; Orbassano Italy
| | - Filomena Longo
- Department of Paediatrics; Centre for Microcitemie; University of Turin; S. Luigi Gonzaga Hospital; Orbassano Italy
| | - Francesca Piccione
- Department of Biological and Clinical Sciences; University of Turin; S. Luigi Gonzaga Hospital; Orbassano Italy
| | - Elisa Pirro
- Department of Biological and Clinical Sciences; University of Turin; S. Luigi Gonzaga Hospital; Orbassano Italy
| | - Jessica Cusato
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin Italy
| | - Antonio D'Avolio
- Department of Medical Sciences; Unit of Infectious Diseases; University of Turin; Amedeo di Savoia Hospital; Turin Italy
| | - Antonio Piga
- Department of Paediatrics; Centre for Microcitemie; University of Turin; S. Luigi Gonzaga Hospital; Orbassano Italy
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Allegra S, Cusato J, De Francia S, Arduino A, Longo F, Pirro E, Massano D, De Nicolò A, Piga A, D'Avolio A. Role of CYP24A1, VDR and GC gene polymorphisms on deferasirox pharmacokinetics and clinical outcomes. THE PHARMACOGENOMICS JOURNAL 2017; 18:506-515. [PMID: 29160302 DOI: 10.1038/tpj.2017.43] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/01/2017] [Accepted: 08/04/2017] [Indexed: 02/06/2023]
Abstract
β-Thalassemia patients develop deficiency in vitamin D absorption and liver hydroxylation, resulting in extremely low calcitriol levels. We explored the role of single-nucleotide polymorphisms (SNPs) involved in vitamin D metabolism, transport and activity on deferasirox pharmacokinetics and outcomes (effectiveness trough levels (Ctrough) and the area under the curve (AUC) cutoffs of 20 μg ml-1 and 360 μg ml-1 h-1, respectively; nonresponse AUC limit of 250 μg ml-1 h-1). Ninety-nine β-thalassemic patients were enrolled. Drug plasma Ctrough and AUC were measured by the high-performance liquid chromatography system coupled with an ultraviolet determination method. Allelic discrimination for VDR, CYP24A1, CYP27B1 and GC gene SNPs was performed by real-time PCR. CYP24A1 22776 TT significantly influenced Cmin and negatively predicted it in regression analysis. CYP24A1 3999 CC was associated with Ctrough and Cmin and was a negative predictor of Tmax, whereas CYP24A1 8620 GG seemed to have a role in Ctrough, AUC, t1/2 and Cmin, and was an AUC negative predictor factor. Considering treatment outcome, Cdx2 and GC 1296 were retained in regression analysis as AUC efficacy cutoff negative predictors.
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Affiliation(s)
- S Allegra
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - J Cusato
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - S De Francia
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - A Arduino
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - F Longo
- Department of Paediatrics, Centre for Microcitemie, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - E Pirro
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - D Massano
- Department of Paediatrics, Centre for Microcitemie, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - A De Nicolò
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - A Piga
- Department of Paediatrics, Centre for Microcitemie, University of Turin, S. Luigi Gonzaga Hospital, Orbassano, Italy
| | - A D'Avolio
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
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Oses C, Olivares B, Ezquer M, Acosta C, Bosch P, Donoso M, Léniz P, Ezquer F. Preconditioning of adipose tissue-derived mesenchymal stem cells with deferoxamine increases the production of pro-angiogenic, neuroprotective and anti-inflammatory factors: Potential application in the treatment of diabetic neuropathy. PLoS One 2017; 12:e0178011. [PMID: 28542352 PMCID: PMC5438173 DOI: 10.1371/journal.pone.0178011] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/06/2017] [Indexed: 12/24/2022] Open
Abstract
Diabetic neuropathy (DN) is one of the most frequent and troublesome complications of diabetes mellitus. Evidence from diabetic animal models and diabetic patients suggests that reduced availability of neuroprotective and pro-angiogenic factors in the nerves in combination with a chronic pro-inflammatory microenvironment and high level of oxidative stress, contribute to the pathogenesis of DN. Mesenchymal stem cells (MSCs) are of great interest as therapeutic agents for regenerative purposes, since they can secrete a broad range of cytoprotective and anti-inflammatory factors. Therefore, the use of the MSC secretome may represent a promising approach for DN treatment. Recent data indicate that the paracrine potential of MSCs could be boosted by preconditioning these cells with an environmental or pharmacological stimulus, enhancing their therapeutic efficacy. In the present study, we observed that the preconditioning of human adipose tissue-derived MSCs (AD-MSCs) with 150μM or 400μM of the iron chelator deferoxamine (DFX) for 48 hours, increased the abundance of the hypoxia inducible factor 1 alpha (HIF-1α) in a concentration dependent manner, without affecting MSC morphology and survival. Activation of HIF-1α led to the up-regulation of the mRNA levels of pro-angiogenic factors like vascular endothelial growth factor alpha and angiopoietin 1. Furthermore this preconditioning increased the expression of potent neuroprotective factors, including nerve growth factor, glial cell-derived neurotrophic factor and neurotrophin-3, and cytokines with anti-inflammatory activity like IL4 and IL5. Additionally, we observed that these molecules, which could also be used as therapeutics, were also increased in the secretome of MSCs preconditioned with DFX compared to the secretome obtained from non-preconditioned cells. Moreover, DFX preconditioning significantly increased the total antioxidant capacity of the MSC secretome and they showed neuroprotective effects when evaluated in an in vitro model of DN. Altogether, our findings suggest that DFX preconditioning of AD-MSCs improves their therapeutic potential and should be considered as a potential strategy for the generation of new alternatives for DN treatment.
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Affiliation(s)
- Carolina Oses
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo. Av. Las Condes, Santiago, Chile
| | - Belén Olivares
- Centro de Química Médica, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo. Av. Las Condes, Santiago, Chile
| | - Marcelo Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo. Av. Las Condes, Santiago, Chile
| | - Cristian Acosta
- Instituto de Histología y Embriología de Mendoza (IHEM-CONICET), Facultad de Medicina, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Paul Bosch
- Facultad de Ingeniería, Universidad del Desarrollo. Av. Plaza, Santiago, Chile
| | - Macarena Donoso
- Facultad de Ingeniería, Universidad del Desarrollo. Av. Plaza, Santiago, Chile
| | - Patricio Léniz
- Unidad de Cirugía Plástica, Reparadora y Estética, Clínica Alemana. Av. Vitacura, Santiago, Chile
| | - Fernando Ezquer
- Centro de Medicina Regenerativa, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo. Av. Las Condes, Santiago, Chile
- * E-mail:
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Allegra S, De Francia S, Cusato J, Arduino A, Massano D, Longo F, Piga A, D'Avolio A. Deferasirox pharmacogenetic influence on pharmacokinetic, efficacy and toxicity in a cohort of pediatric patients. Pharmacogenomics 2017; 18:539-554. [PMID: 28346059 DOI: 10.2217/pgs-2016-0176] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIM We aimed to evaluate the influence of genetic polymorphisms involved in deferasirox metabolism and transport on its pharmacokinetics and treatment toxicity, in a cohort of β-thalassaemic children. PATIENTS & METHODS Drug plasma concentrations were measured by a HPLC-UV method. Allelic discrimination for UGT1A1, UGT1A3, CYP1A1, CYP1A2, CYP2D6, MRP2 and BCRP1 polymorphisms was performed by real-time PCR. RESULTS CYP1A1 rs2606345AA influenced Ctrough (p = 0.001) and t1/2 (p = 0.042), CYP1A1 rs4646903TC/CC (p = 0.005) and BCRP1 rs2231142GA/AA (p = 0.005) influenced Tmax and CYP2D6 rs1135840CG/GG influenced Cmax (p = 0.044). UGT1A1 rs887829TT (p = 0.002) and CYP1A2 rs762551CC (p = 0.019) resulted as predictive factor of ferritin levels and CYP1A1 rs2606345CA/AA (p = 0.021) and CYP1A2 rs762551AC/CC (p = 0.027) of liver iron concentration. CONCLUSION Our data suggest the usefulness of deferasirox pharmacogenetics in pediatric treatment optimization.
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Affiliation(s)
- Sarah Allegra
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
| | - Silvia De Francia
- Department of Biological & Clinical Sciences, S Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano (TO), Italy
| | - Jessica Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
| | - Arianna Arduino
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
| | - Davide Massano
- Department of Biological & Clinical Sciences, S Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano (TO), Italy
| | - Filomena Longo
- Department of Biological & Clinical Sciences, S Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano (TO), Italy
| | - Antonio Piga
- Department of Biological & Clinical Sciences, S Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano (TO), Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
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Allegra S, De Francia S, Longo F, Massano D, Cusato J, Arduino A, Pirro E, Piga A, D'Avolio A. Deferasirox pharmacokinetics evaluation in a woman with hereditary haemochromatosis and heterozygous β-thalassaemia. Biomed Pharmacother 2016; 84:1510-1512. [PMID: 27881236 DOI: 10.1016/j.biopha.2016.11.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 01/19/2023] Open
Abstract
We present the deferasirox pharmacokinetics evaluation of a female patient on iron chelation, for the interesting findings from her genetic background (hereditary haemochromatosis and heterozygous β-thalassaemia) and clinical history (ileostomy; iron overload from transfusions). Drug plasma concentrations were measured by an HPLC-UV validated method, before and after ileum resection. Area under deferasirox concentration curve over 24h (AUC) values were determined by the mixed log-linear rule, using Kinetica software. AUC was low also with high deferasirox dose as well as tolerability. Non invasive tissue iron quantification by magnetic resonance imaging or superconducting quantum interference device were prevented by a metal hip replacement. Good efficacy and normalisation of iron markers was obtained on long term. Therapeutic drug monitoring in patient in critical conditions may help to understand reasons for non response and set individualised treatment.
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Affiliation(s)
- Sarah Allegra
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149, Turin, Italy.
| | - Silvia De Francia
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Filomena Longo
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Davide Massano
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Jessica Cusato
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149, Turin, Italy
| | - Arianna Arduino
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149, Turin, Italy
| | - Elisa Pirro
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Antonio Piga
- Department of Biological and Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano (TO), Italy
| | - Antonio D'Avolio
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera 164, 10149, Turin, Italy
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19
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Lin HJ, Hsieh KP, Chiou SS, Kou HS, Wu SM. Determination of deferasirox in human plasma by short-end injection and sweeping with a field-amplified sample stacking and micellar electrokinetic chromatography. J Pharm Biomed Anal 2016; 131:497-502. [DOI: 10.1016/j.jpba.2016.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 01/19/2023]
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Allegra S, De Francia S, Cusato J, Pirro E, Massano D, Piga A, D'Avolio A. Deferasirox pharmacokinetic and toxicity correlation in β-thalassaemia major treatment. ACTA ACUST UNITED AC 2016; 68:1417-1421. [PMID: 27672004 DOI: 10.1111/jphp.12638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Deferasirox adverse effects include the following: gastrointestinal disturbance, mild elevations in serum creatinine levels and intermittent proteinuria; these events are dose-dependent and reversible with drug discontinuation, but this solution can lead to an inadequate iron chelation. For these reasons, interindividual variability of drug plasma concentration could help the clinical management of deferasirox dosage. We sought to describe deferasirox plasma exposure in a cohort of 60 adult patients. METHODS A fully validated chromatographic method was used to quantify deferasirox concentration in plasma collected from β-thalassaemia adult patients. Samples obtained before and after 2, 4, 6 and 24 h drug administration were evaluated. Associations between variables were tested using the Pearson test. KEY FINDINGS Concerning pharmacokinetic parameters, a higher interindividual variability was shown. A positive correlation was found between deferasirox area under the concentration curve over 24 h and serum creatinine (r = 0.314; P = 0.018) and between area and drug dose (r = 0.311; P = 0.016). Moreover, a negative correlation resulted among area under the concentration curve over 24 h and serum ferritin (r = -0.291; P = 0.026) and among drug half-life and its dose (r = -0.319; P = 0.013). CONCLUSIONS Treatment decision based on the individual characteristics could strongly contribute to minimize toxicity and increase efficacy of deferasirox therapy.
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Affiliation(s)
- Sarah Allegra
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Silvia De Francia
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano (TO), Italy
| | - Jessica Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Elisa Pirro
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano (TO), Italy
| | - Davide Massano
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano (TO), Italy
| | - Antonio Piga
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano (TO), Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy.
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21
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Allegra S, Cusato J, De Francia S, Pirro E, Massano D, Piga A, D'Avolio A. Deferasirox pharmacokinetic evaluation in β-thalassaemia paediatric patients. ACTA ACUST UNITED AC 2016; 69:525-528. [PMID: 27230486 DOI: 10.1111/jphp.12559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Iron chelation in the transfusion-dependent anaemias management is essential to prevent end-organ damage and to improve survival. Deferasirox is a once-daily orally active tridentate selective iron chelator which pharmacokinetic disposition could influence treatment efficacy and toxicity. Therapeutic drug monitoring is an important tool for optimizing drug utilization and doses. METHODS A fully validated chromatographic method was used to quantify deferasirox concentration in plasma collected from paediatric patients with β-thalassaemia. Samples obtained after 5 days of washout or in naïve patients before and after 2, 4, 6 and 24 h drug administration were evaluated. KEY FINDINGS Associations between variables were tested using the Pearson test. Twenty paediatric patients were enrolled; they were mainly men (13.65%), with median age of 6.35 years and body mass index of 15.45 kg/m2 . Concerning pharmacokinetic parameters, a higher interindividual variability was shown. A positive, but not significant, correlation (r = 0.363; P = 0.115) was found between deferasirox area under the concentration curve over 24 h (AUC) and drug dose. CONCLUSIONS Monitoring plasma deferasirox concentrations appears beneficial for guiding appropriate patient treatment, enhancing effectiveness and minimizing toxicity.
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Affiliation(s)
- Sarah Allegra
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Jessica Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Silvia De Francia
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Elisa Pirro
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Davide Massano
- Department of Pediatrics, Centre for Microcitemie, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Antonio Piga
- Department of Pediatrics, Centre for Microcitemie, S. Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Turin, Turin, Italy
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22
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Allegra S, Cusato J, De Francia S, Massano D, Piga A, D'Avolio A. Deferasirox AUC efficacy cutoff and role of pharmacogenetics. Eur J Clin Pharmacol 2016; 72:1155-7. [PMID: 27193993 DOI: 10.1007/s00228-016-2070-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 01/19/2023]
Affiliation(s)
- S Allegra
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital University of TorinoCorso Svizzera 16410149 TurinItaly, University of Turin, 10149, Turin, Italy
| | - J Cusato
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital University of TorinoCorso Svizzera 16410149 TurinItaly, University of Turin, 10149, Turin, Italy
| | - S De Francia
- Department of Biological and Clinical Sciences, S. Luigi Gonzaga Hospital, University of Turin, 10043, Orbassano, TO, Italy
| | - D Massano
- Department of Pediatrics, Centre for Microcitemie, S. Luigi Gonzaga Hospital, University of Turin, 10043, Orbassano, TO, Italy
| | - A Piga
- Department of Pediatrics, Centre for Microcitemie, S. Luigi Gonzaga Hospital, University of Turin, 10043, Orbassano, TO, Italy
| | - A D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, Unit of Infectious Diseases, Amedeo di Savoia Hospital University of TorinoCorso Svizzera 16410149 TurinItaly, University of Turin, 10149, Turin, Italy.
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23
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Cusato J, Allegra S, De Francia S, Massano D, Piga A, D'Avolio A. Role of pharmacogenetics on deferasirox AUC and efficacy. Pharmacogenomics 2016; 17:561-72. [PMID: 27043265 DOI: 10.2217/pgs-2015-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIM We evaluated deferasirox pharmacokinetic according to SNPs in genes involved in its metabolism and elimination. Moreover, we defined a plasma area under the curve cut-off value predicting therapy response. PATIENTS & METHODS Allelic discrimination was performed by real-time PCR. Drug plasma concentrations were measured by a high performance liquid chromatography system coupled with an ultraviolet method. RESULTS Pharmacokinetic parameters were significantly influenced by UGT1A1 rs887829C>T, UGT1A3 rs1983023C>T and rs3806596A>G SNPs. Area under the curve cut-off values of 360 μg/ml/h for efficacy were here defined and 250 μg/ml/h for nonresponse was reported. UGT1A3 rs3806596GG and ABCG2 rs13120400CC genotypes were factors able to predict efficacy, whereas UGT1A3 rs3806596GG was a nonresponse predictor. CONCLUSION These data show how screening patient's genetic profile may help clinicians to optimize iron chelation therapy with deferasirox.
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Affiliation(s)
- Jessica Cusato
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Sarah Allegra
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy
| | - Silvia De Francia
- Department of Biological & Clinical Sciences, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Davide Massano
- Department of Pediatrics, Centre for Microcitemie, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Antonio Piga
- Department of Pediatrics, Centre for Microcitemie, University of Turin, S. Luigi Gonzaga Hospital, 10043 Orbassano (TO), Italy
| | - Antonio D'Avolio
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy.,Laboratory of Clinical Pharmacology & Pharmacogenetics, Department of Medical Sciences, Unit of Infectious Diseases, University of Torino, Amedeo di Savoia Hospital, Corso Svizzera 164-10149 Turin, Italy
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Influence of single-nucleotide polymorphisms on deferasirox C trough levels and effectiveness. THE PHARMACOGENOMICS JOURNAL 2014; 15:263-71. [PMID: 25348619 DOI: 10.1038/tpj.2014.65] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/30/2014] [Accepted: 09/19/2014] [Indexed: 01/19/2023]
Abstract
Deferasirox (DFX) is the only once-daily oral chelator for iron overload and its pharmacokinetic has been related with response to therapy. Our aim was to evaluate DFX plasma concentrations according to single-nucleotide polymorphisms in genes involved in its metabolism (UGT1A1, UGT1A3, CYP1A1, CYP1A2 and CYP2D6) and elimination (MRP2 and BCRP1). Further aim was to define a plasma concentration cutoff value predicting an adequate response to therapy. Plasma concentrations were determined at the end of dosing interval (C trough) using an high-performance liquid chromatography-ultraviolet method. Allelic discrimination was performed by real-time PCR. C trough levels were influenced by UGT1A1C>T rs887829, CYP1A1C>A rs2606345, CYP1A2A>C rs762551, CYP1A2C>T rs2470890 and MRP2G>A rs2273697 polymorphisms. A DFX plasma efficacy cutoff value of 20,000 ng ml(-1) was identified; CYP1A1C>A rs2606345 AA and CYP1A2C>T rs2470890 TT genotypes may predict this value, suggesting a negative predictive role in therapy efficacy. Our data suggest the feasibility of a pharmacogenetic-based DFX dose personalization.
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Mattioli F, Puntoni M, Marini V, Fucile C, Milano G, Robbiano L, Perrotta S, Pinto V, Martelli A, Forni GL. Determination of deferasirox plasma concentrations: do gender, physical and genetic differences affect chelation efficacy? Eur J Haematol 2014; 94:310-7. [PMID: 25081908 DOI: 10.1111/ejh.12419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Bioavailability of deferasirox (DFX) is significantly affected by the timing of administration relative to times and to composition of meals. Its elimination half-life is also highly variable - in some patients as a result of gene polymorphisms. Understanding whether deferasirox plasma levels are related to specific characteristics of patients could help physicians to devise a drug regimen tailored the individual patient. METHODS We analyzed deferasirox plasma concentrations (CDFX ) in 80 patients with transfusion-dependent anemias, such as thalassemia, by a high performance liquid chromatography (HPLC) assay. We used a multivariate linear regression model to find significant associations between CDFX and clinical/demographical characteristics of patients. All patients were genotyped for UGT1A1. RESULTS Fifty-six patients were female, 24 were male, the great majority (88%) affected by β-thalassemia, and 15 were children and adolescents. No statistical correlation was detectable between CDFX and DFX dose (P = 0.6). Age, time from last drug intake to blood sampling, and ferritin levels in the 6 months before study initiation were significantly and inversely associated with CDFX in univariate analysis. In the multivariate analysis, the only two factors independently and inversely associated with CDFX levels were time from last drug intake to blood sampling and ferritin levels (P = 0.006). A significant inverse correlation (P = 0.03) was observed between CDFX and UGT1A1*28 gene polymorphism, but only in patients with levels of lean body mass (LBM) below the median (P for interaction = 0.05). CONCLUSIONS The results could indicate that a higher plasma DFX concentration could be associated with greater chelation efficacy. As a correlation between dose and CDFX was not demonstrated, it seems useful to monitor the concentrations to optimize and determine the most appropriate dose for each patient. Interesting results emerged from the analysis of genetic and physical characteristics of patients: LBM was a borderline significant effect modifier of the relationship between UGT1A1 polymorphisms and CDFX . Individual patient-tailored dosing of DFX should help to improve iron chelation efficacy and to reduce dose-dependent drug toxicity.
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Affiliation(s)
- Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
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