Development of a fast HPLC-DAD method for simultaneous quantitation of three immunosuppressant drugs in whole blood samples using intelligent chemometrics resolving of coeluting peaks in the presence of blood interferences

Overview of therapeutic drug monitoring and clinical practice

With the rapid development of clinical pharmacy in China, therapeutic drug monitoring (TDM) has become an essential tool for guiding rational clinical drug use and is widely concerned. TDM is a tool that combines pharmacokinetic and pharmacodynamic knowledge to optimize personalized drug therapy, which can improve treatment outcomes, reduce drug-drug toxicity, and avoid the risk of developing drug resistance. To effectively implement TDM, accurate and sophisticated analytical methods are required. By researching the literature published in recent years, we summarize the types of commonly monitored drugs, therapeutic windows, and clinical assays and track the trends and hot spots of therapeutic drug monitoring. The purpose is to provide guidelines for clinical blood drug concentration monitoring, to implement individualized drug delivery programs better, to ensure the rational use of drugs for patients, and to provide a reference for the group to carry out related topics in the future.

A simple and accurate LC‑MS/MS method for monitoring cyclosporin A that is suitable for high throughput analysis

With time, the number of samples in clinical laboratories from therapeutic drug monitoring has increased. Existing analytical methods for blood cyclosporin A (CSA) monitoring, such as high-performance liquid chromatography (HPLC) and immunoassays, have limitations including cross-reactivity, time consumption, and the complicated procedures involved. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has long been considered the reference standard owing to its high accuracy, specificity, and sensitivity. However, large numbers of blood samples, multi-step preparation procedures, and longer analytical times (2.5-20 min) are required as a consequence of the different technical strategies, to ensure good analytical performance and routine quality assurance. A stable, reliable, and high throughput detection method will save personnel time and reduce laboratory costs. Therefore, a high throughput and simple LC-MS/MS method was developed and validated for the detection of whole-blood CSA with CSA-d12 as the internal standard in the present study. Whole blood samples were prepared through a modified one-step protein precipitation method. A C18 column (50x2.1 mm, 2.7 µm) with a mobile phase flow rate of 0.5 ml/min was used for chromatographic separation with a total running time of 4.3 min to avoid the matrix effect. To protect the mass spectrometer, only part of the sample after LC separation was allowed to enter the mass spectrum, using two HPLC systems coupled to one mass spectrometry. In this way, throughput was improved with detection of two samples possible within 4.3 min using a shorter analytical time for each sample of 2.15 min. This modified LC-MS/MS method showed excellent analytical performance and demonstrated less matrix effect and a wide linear range. The design of multi-LC systems coupled with one mass spectrometry may play a notable role in the improvement of daily detection throughput, speeding up LC-MS/MS, and allowing it to be an integral part of continuous diagnostics in the near future.

[Rapid and simultaneous determination of two immunosuppressants in whole blood by high performance liquid chromatography]

Cyclosporine A and sirolimus are immunosuppressants that are widely used in many organ transplantation procedures. They exhibit some complementary mechanisms of action and interact synergistically when used together. However， they are critical-dose drugs and have a narrow therapeutic index. They provide the desired therapeutic effect with acceptable tolerability only within a specific range of blood concentrations. Therefore， the rapid and simultaneous detection of the concentrations of cyclosporine A and sirolimus in whole blood could provide valuable information on planning medicine administration after organ transplantations. In this study， firstly， the chromatographic behaviors of cyclosporine A and sirolimus on a biological liquid chromatography （BioLC） column and traditional liquid chromatography （TraLC） columns were investigated systematically under the same chromatographic conditions. The results suggested that the peak height and peak width of cyclosporine A and sirolimus on the BioLC column， ZORBAX 300SB C8 （250 mm×4.6 mm， 5.0 μm）， were the highest and narrowest， respectively. The number of theoretical plates of cyclosporine A and sirolimus on the ZORBAX 300SB C8 column increased significantly when the volume ratio of acetonitrile in the mobile phases was greater than 70%. Their retention time on the BioLC and TraLC columns was negligibly affected by the use of formic acid and trifluoroacetic acid as the mobile phases. In the range of the experimental column temperature， the number of theoretical plates of cyclosporine A and sirolimus on the ZORBAX 300SB C8 column was significantly higher than that on the two TraLC columns. Furthermore， the relationship between the retention factor and column temperature of cyclosporine A on the ZORBAX 300SB C8 column was different from that on the two TraLC columns. Subsequently， a high performance liquid chromatography method based on the ZORBAX 300SB C8 column was established for the rapid separation and determination of cyclosporin A and sirolimus in whole blood. A sample of whole blood with a volume of 50 μL was prepared by protein precipitation with 1 mol/L sodium hydroxide and then extracted into 500 μL of ether-methanol （95∶5， v/v）. After centrifugation at 14000 r/min for 10 min， the organic layer was removed and evaporated under a stream of nitrogen at 50 ℃. The residue was then reconstituted in 200 μL of methanol for use. Cyclosporin A and sirolimus were separated through isocratic elution on the ZORBAX 300SB C8 column. The column temperature was set at 60 ℃. The mobile phase was acetonitrile-water （70∶30， v/v） and the flow rate was 1.0 mL/min. The detection wavelengths were 205 nm for cyclosporine A and 278 nm for sirolimus. The injection volume was 20 μL. The external standard method was used to quantify cyclosporine A and sirolimus. Under the optimized conditions， cyclosporine A and sirolimus were well-separated within 6 min with a resolution of 3.7 at 205 nm. In addition， the endogenous substances in whole blood negligibly interfered in the detection of sirolimus， while two endogenous substances slightly affected the detection of cyclosporine A. Cyclosporine A and sirolimus both showed good linear relationships in their respective concentration （r>0.997）. The limits of detection （LODs） of cyclosporine A and sirolimus were respectively calculated to be 10 ng/mL and 1 ng/mL based on a signal-to-noise ratio of 3， and the limits of quantification （LOQs） were 30 ng/mL and 2 ng/mL based on a signal-to-noise ratio of 10. In the whole blood samples， the recoveries of cyclosporine A and sirolimus at three spiked levels were in the ranges of 83.5%-89.7% and 95.8%-97.8% with relative standard deviations （RSDs） of 3.2%-9.0% and 3.4%-6.7% （n=5）， respectively. The established method is simple in operation， can be performed with a simple mobile phase， has a short analysis time， and provides a wide linear range and high sensitivity； hence， it can be applied to the determination of cyclosporine A and sirolimus in whole blood.

Simultaneous Determination of Six Immunosuppressants in Human Whole Blood by HPLC-MS/MS Using a Modified QuEChERS Method

A high-performance liquid chromatography-tandem mass spectrometry method was established for the simultaneous determination of mycophenolic acid, mycophenolate mofetil, tacrolimus, rapamycin, everolimus and pimecrolimus in human whole blood by optimizing the QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) preparation method. Whole blood was extracted into ethyl acetate, salted out with anhydrous magnesium sulfate, and purified with ethylenediamine-N-propyl silane adsorbent. The supernatant was evaporated under nitrogen until dry and finally reconstituted in methanol. Chromatographic separation was performed on an Agilent Poroshell 120 EC-C18 column in methanol (mobile phase A)-water (optimized for 0.1% acetic acid and 10 mM ammonium acetate, mobile phase B) at a 0.3 mL·min−1 flow rate. Electrospray ionization and positive ion multiple reaction monitoring were used for detection. The time for of analysis was 13 min. The calibration curves range of tacrolimus, rapamycin, everolimus and pimecrolimus were in the range of 1−100 ng·mL−1, mycophenolate mofetil in the range of 0.1−10 ng·mL−1 and mycophenolic acid at 10−1000 ng·mL−1. All correlation coefficients were >0.993. The coefficients of variation (CV, %) for inter-day and intra-day precision were less than 10%, while the spiked recoveries were in the range of 92.1% to 116%. Our method was rapid, sensitive, specific, and reproducible for the simultaneous determination of six immunosuppressants in human whole blood. Importantly, our approach can be used to monitor drug concentrations in the blood to facilitate disease treatment.

Chromatographic Applications in the Multi-Way Calibration Field

In this review, recent advances and applications using multi-way calibration protocols based on the processing of multi-dimensional chromatographic data are discussed. We first describe the various modes in which multi-way chromatographic data sets can be generated, including some important characteristics that should be taken into account for the selection of an adequate data processing model. We then discuss the different manners in which the collected instrumental data can be arranged, and the most usually applied models and algorithms for the decomposition of the data arrays. The latter activity leads to the estimation of surrogate variables (scores), useful for analyte quantitation in the presence of uncalibrated interferences, achieving the second-order advantage. Recent experimental reports based on multi-way liquid and gas chromatographic data are then reviewed. Finally, analytical figures of merit that should always accompany quantitative calibration reports are described.

The Application of Chemometrics for Efficiency Enhancement and Toxicity Reduction in Cancer Treatment with Combined Therapy

Chemometrics is an important emerging discipline with unique charm formed by the intersection of mathematics, statistics, chemistry and computer science. The application of chemometrics in the field of pharmacy has injected fresh blood into the scientific research and clinical practice of medicine and has provided a sufficient scientific basis for drug analysis and content determination to solve the problem of cancer treatment with combined therapy in different ranges. This paper introduces the basic principles, advantages and disadvantages of several commonly used pattern recognition and multidimensional correction methods of chemometrics, reviews the application of chemometrics for efficiency enhancement and toxicity reduction in cancer treatment with combined therapy and summarizes its development and prospects in the future.

Overview of therapeutic drug monitoring of immunosuppressive drugs: Analytical and clinical practices

Immunosuppressant drugs (ISDs) play a key role in short-term patient survival together with very low acute allograft rejection rates in transplant recipients. Due to the narrow therapeutic index and large inter-patient pharmacokinetic variability of ISDs, therapeutic drug monitoring (TDM) is needed to dose adjustment for each patient (personalized medicine approach) to avoid treatment failure or side effects of the therapy. To achieve this, TDM needs to be done effectively. However, it would not be possible without the proper clinical practice and analytical tools. The purpose of this review is to provide a guide to establish reliable TDM, followed by a critical overview of the current analytical methods and clinical practices for the TDM of ISDs, and to discuss some of the main practical aspects of the TDM.

Development and validation of a simple and versatile method for the quantification of everolimus loaded in H-ferritin nanocages using UHPLC-MS/MS

Everolimus (Eve) is an immunosuppressive macrolide that is being analyzed in various biological matrices and fluids. Its antitumor activity makes this drug suitable not only for organ transplantation but also for breast cancer treatments. In the attempt to reduce the incidence and severity of its side effects, Eve was loaded in H-ferritin (HFn), a natural biomolecule that is involved in specific cellular uptake pathways. Thus, Eve pre-complexed with Cu(II) and encapsulated in HFn resulted in an Eve nanoformulation, named HEve. The quantification of HEve was performed using a tailored pH-induced procedure to precipitate H-ferritin. This sample preparation was effective enough to reduce the ion suppression effect on the mass spectrometric responses of Eve in electrospray ionization (ESI). The ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-ESI-MS/MS) system operating in positive ionization mode showed to be a versatile technique in achieving more than 77 % recovery of Eve from the cytoplasmic compartment. This simple, selective and sensitive method enabled the quantification of Eve within the linear range of 2.5-100 ng/mL in matrix spiked with the isotope-labeled internal standard, EveD4. This method was validated according to FDA Guidance. The intracellular distribution of HEve and its accumulation at a cytoplasmic level were studied in breast cancer cell lines. As expected, HEve was more effective than free Eve on sensitive (i.e. BT474) and resistant cell lines, as a result of a better penetration into the target subcellular compartment.

Review of Chromatographic Methods Coupled with Modern Detection Techniques Applied in the Therapeutic Drugs Monitoring (TDM)

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.

A Comprehensive Review on Developed Pharmaceutical Analysis Methods by Iranian Analysts in 2018

This article summarizes the publishing activities including bioanalytical and pharmaceutical analyses researches carried out in Iran in 2018 in order to connect academic researchers to those in industry, medical care units and hospitals. A wide spectrum of analytical methods has been used to determine and/or evaluate drug levels in the biological samples, based on physical, chemical and biochemical principles. We have compiled a concise survey of the literature covering 125 reports and tabulated the relevant analytical parameters. Chromatographic and electrochemical methods were found to be the technique of choice for many workers and almost 83% studies were performed by using these methods. This is the first annual review of the literature searching in SCOPUS database for published bioanalytical and pharmaceutical analysis researches in Iran.

Development of a sensitive electrochemical immunosensor using polyaniline functionalized graphene quantum dots for detecting a depression marker

As a new type of conductive material, polyaniline functionalized graphene quantum dots (PAGD), which were prepared by in-situ polymerization had been used to construct a novel electrochemical immunosensor for early screening of depression markers-heat shock protein 70 (HSP70). Profiting from the huge specific surface area, good bioactivity and excellent structure of PAGD, a variety of heat shock protein 70 (HSP70) was firmly loaded on the surface of PAGD for successful construction of basic electrode (HSP70/PAGD/GCE), which was characterized by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS), respectively. Due to the HSP70 fixed on the surface of basic electrode and the HSP70 in the samples can competitively combine with the horseradish peroxidase labeled human HSP70 antibody (HRP-Strept-Biotin-Ab). As a result, there is negative correlation between the concentration of HSP70 in samples and the detection signal of the proposed electrochemical immunosensor (HRP-Strept-Biotin-Ab-HSP70/PAGD/GCE) in the test liquid. Under conditions optimized for determining HSP70, wide linearity was obtained in the range of 0.0976-100 ng/mL, with a low detection limit of 0.05 ng/mL at 3σ. Moreover, the proposed electrochemical immunosensors was successfully applied to detect HSP70 in plasma samples, and exhibited good precision, acceptable stability and reproducibility. Therefore, this study provides a novel and convenient method for early clinical screening of depression markers, and also provides a reliable and objective analysis method for the diagnosis of depression at the molecular level.

On-Site Therapeutic Drug Monitoring

Recent technological advances have stimulated efforts to bring personalized medicine into practice. Yet, traditional application fields like therapeutic drug monitoring (TDM) have remained rather under-appreciated. Owing to clear dose-response relationships, TDM could improve patient outcomes and reduce healthcare costs. While chromatography-based routine practices are restricted due to high costs and turnaround times, biosensors overcome these limitations by offering on-site analysis. Nevertheless, sensor-based approaches have yet to break through for clinical TDM applications, due to the gap between scientific and clinical communities. We provide a critical overview of current TDM practices, followed by a TDM guideline to establish a common ground across disciplines. Finally, we discuss how the translation of sensor systems for TDM can be facilitated, by highlighting the challenges and opportunities.

Sensitive UHPLC–MS/MS method for the determination of tacrolimus in minipig whole blood

Background: Tacrolimus, a potent immunosuppressant drug widely used systemically to reduce the risk of organ rejection in transplants, has been repositioned for topical treatment of atopic dermatitis. Results & methodology: This work describes the optimization of a new method for the determination of tacrolimus in whole blood after topical administration. Sample treatment consisted of an automated procedure based on protein precipitation followed by solid-phase extraction. The present method showed good performance with quantitation limits of 10 pg ml-1 and intra- and interday precision and accuracy lower than 15 and 10%, respectively. Conclusion: A new highly sensitive UHPLC–MS/MS method has been developed enabling a better characterization of the minipig blood plasma pharmacokinetic behavior of tacrolimus after topical administration.

Contribution to second-order calibration based on multivariate curve resolution with and without previous chromatographic synchronization

Rotational ambiguity in the bilinear solutions provided by multivariate curve resolution - alternating least-squares (MCR-ALS) leads to an additional source of uncertainty in the estimation of analyte concentrations by second-order multivariate calibration. The phenomenon is particularly important when measuring matrix instrumental data derived from liquid chromatography with spectral detection, where elution time profiles usually vary from sample to sample both in position and shape. This makes the data non-trilinear, precluding the use of unique trilinear decomposition models. The present report compares some analytical results achieved by: (1) the usual MCR-ALS analysis of augmented matrices built from raw matrix data and (2) a previously reported procedure based on synchronizing the MCR-ALS elution time profiles using correlation optimized warping (COW), reconstructing the augmented matrix with the spectra and the aligned chromatograms, and then applying MCR-ALS again with the trilinearity constraint, leading to unique solutions, which is possible because the warping process restores the trilinearity of the data. We show that alternative (2) does not solve the rotational ambiguity issues and artificially modifies the original data, without significant improvements in analytical performance. In the simulated systems, the best average errors for alternative (1) were about 2%, whereas for alternative (2) they were in the range 4-11%. For the experimental system, the corresponding errors were 2-3% and 3-4% respectively, i.e. with no significant improvement in going to alternative (2). All efforts should be directed to reduce the degree of rotational ambiguity by applying a full battery of chemically reasonable constraints.

A multidrug LC–MS/MS method for the determination of five immunosuppressants in oral fluid

Aim: This study aimed: to develop and validate an LC–MS/MS method for mycophenolic acid, tacrolimus, sirolimus, everolimus and cyclosporin A in oral fluid (OF), as an essential tool to study the usefulness of OF as an alternative matrix for immunossuppressants’ therapeutic drug monitoring; and to find the best OF collector for these analytes. Materials & Methods: Chromatographic separation was achieved using an XBridge® Shield RP18 analytical column maintained at 65ºC, using 2 mM ammonium formate and 0.1% formic acid in water (A) and acetonitrile (B) as mobile phase. OF sample was extracted with solid phase extraction after sonication and protein precipitation. Results & Conclusions: Method validation met all the acceptance criteria. LODs were 0.05–1 ng/ml, and LOQs 0.1–5 ng/ml. Silanized tubes offered the best recoveries. The method was successfully applied to 31 OF specimens, describing everolimus detection in OF for the first time. Conclusion: The proposed method is sensitive enough for the detection of OF trough concentrations in patients receiving immunosuppressants when using an appropriate OF collector.

Rapid, simultaneous and interference-free determination of three rhodamine dyes illegally added into chilli samples using excitation-emission matrix fluorescence coupled with second-order calibration method

In this study, a smart and green analytical method based on the second-order calibration algorithm coupled with excitation-emission matrix (EEM) fluorescence was developed for the determination of rhodamine dyes illegally added into chilli samples. The proposed method not only has the advantage of high sensitivity over the traditional fluorescence method but also fully displays the "second-order advantage". Pure signals of analytes were successfully extracted from severely interferential EEMs profiles via using alternating trilinear decomposition (ATLD) algorithm even in the presence of common fluorescence problems such as scattering, peak overlaps and unknown interferences. It is worth noting that the unknown interferents can denote different kinds of backgrounds, not only refer to a constant background. In addition, the method using interpolation method could avoid the information loss of analytes of interest. The use of "mathematical separation" instead of complicated "chemical or physical separation" strategy can be more effective and environmentally friendly. A series of statistical parameters including figures of merit and RSDs of intra- (≤1.9%) and inter-day (≤6.6%) were calculated to validate the accuracy of the proposed method. Furthermore, the authoritative method of HPLC-FLD was adopted to verify the qualitative and quantitative results of the proposed method. Compared with the two methods, it also showed that the ATLD-EEMs method has the advantages of accuracy, rapidness, simplicity and green, which is expected to be developed as an attractive alternative method for simultaneous and interference-free determination of rhodamine dyes illegally added into complex matrices.