A dried blood spot assay for paclitaxel and its metabolites

Phase I study of intraperitoneal aerosolized nanoparticle albumin based paclitaxel (NAB-PTX) for unresectable peritoneal metastases

Background

Pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a novel method to treat patients with peritoneal metastases (PM). We aimed to study the tolerability, safety, pharmacokinetics, and tumour response of nanoparticle albumin bound paclitaxel (NAB-PTX) during PIPAC in a Phase I study.

Methods

Eligible patients with biopsy-proven PM from ovarian, breast, gastric, hepatobiliary, or pancreatic origin underwent three PIPAC treatments using NAB-PTX with a four-week interval. The dose of NAB-PTX was escalated from 35 to 140 mg/m² using a Bayesian design to estimate the maximum tolerated dose (MTD).

Findings

Twenty-three patients were included; thirteen (65%) patients combined PIPAC therapy with continued systemic chemotherapy. The most frequent toxicities were liver toxicity and anaemia. Treatment resulted in seven (35%) responders, six (30%) non-responders and seven (35%) patients with stable PM. Systemic absorption of NAB-PTX was slow, with median peak plasma concentrations reached after 3 to 4 h. Median NAB-PTX tumour tissue concentrations suggested accumulation: 14.6 ng/mg, 19.2 ng/mg and 40.8 ng/mg after the first, second and third PIPAC procedure respectively. EORTC QoL and VAS scores remained stable. Overall survival after one year was 57%.

Interpretation

PIPAC with NAB-PTX results in a favourable PK profile and promising anticancer activity in patients with unresectable PM. The MTD and recommended Phase II clinical trial dose are 140 mg/m². In patients with impaired hepatobiliary function, a dose of 112.5 mg/m² is recommended.

Funding

Kom op tegen Kanker (Flemish League against Cancer).

A Joint Technology Combining the Advantages of Capillary Microsampling with Mass Spectrometry Applied to the Trans-Resveratrol Pharmacokinetic Study in Mice

Mice are the most frequently used animals in pharmacokinetic studies; however, collecting series of blood samples from mice is difficult because of their small sizes and tiny vessels. In addition, due to the small sample size, it is problematic to perform high required quantification. Thus, present work aims to find an effective strategy for overcoming these challenges using trans-resveratrol as a tool drug. Based on the idea of a joint technology, the capillary microsampling (CMS) was chosen for blood sample collection from mice after delivery of trans-resveratrol (150 mg/kg) by gavage, and a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method was developed for the determination of trans-resveratrol and its main metabolites. All the mouse blood samples were exactly collected by CMS without obvious deviation. This provided credible samples for subsequent quantitative analysis. The HPLC-MS/MS method was found to be sensitive, accurate, and repeatable, and the pharmacokinetic parameters for all analytes were comparable with those reported in previous studies. However, the present joint technology offers the advantages of less animal damage, easy for sample preparation, and improved reliability. It has overcome some of the major limitations revealed in previous pharmacokinetic studies in mice and therefore provides a more effective option for future studies.

Screening of Synthetic Cathinones and Metabolites in Dried Blood Spots by UPLC-MS-MS

After its use for decades in clinical screening, dried blood spots (DBS) have recently received considerable attention for their application in various novel psychoactive substances. The goal of this study was to develop and apply a DBS-based assay for 37 synthetic cathinones and their metabolites. Thirty microliters of whole blood sample after administration was spotted onto Whatman FTA classical cards, dried and extracted, and then analyzed by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS). The samples were chromatographed on a Waters Acquity UPLC®HSS T3 column (1.8 μm, 2.1 × 100 mm) and then identically packed defender guard cartridges of a Waters Acquity UPLC®HSS T3 column (1.8 μm, 2.1 × 5 mm, 3/pk). The separation was achieved via solvents of 20 mM ammonium acetate/formic acid 0.1% (A) and acetonitrile (B) at a flow rate of 0.25 mL/min. A tandem MS equipped with positive electrospray ionization mode source was used as the detector. Multiple reaction monitoring with the precursor/product ion combinations was used to quantify each analyte. The linear range of synthetic cathinones in the DBS was 2.0-200 ng/mL, and the lowest limit of quantification was 2.0 ng/mL for some synthetic cathinones and 10 ng/mL for others. The precision and accuracy of the results for the validation samples of the synthetic cathinones were within acceptable criteria. DBS sampling offers the advantages of reduced sample volume and convenient sample storage and shipment. This method can be successfully applied to the quantification of synthetic cathinones.

Interactions of Some Chemotherapeutic Agents as Epirubicin, Gemcitabine and Paclitaxel in Multicomponent Systems Based on Orange Essential Oil

In order to anticipate the effect induced by a natural product on the chemical activity of medicines simultaneously administered, spontaneous interactions of certain cancer treatment drugs such as, epirubicin (EPR), gemcitabine (GCT), and paclitaxel (PTX) with limonene (LIM)—a natural compound extracted from orange peel and known as an anticancer agent—were investigated. To estimate the stability of the drugs over time, a current density of 50 mA cm⁻² was applied as an external stimulus between two platinum electrodes immersed in hydrochloric acid solution containing ethyl alcohol/water in the volume ratio of 2/3, in the absence and presence of orange essential oil (limonene concentration of 95%). The concentration variation of chemotherapeutic agents over time was evaluated by UV-Vis spectrophotometry. Kinetic studies have shown a delay in the decomposition reaction of epirubicin and gemcitabine and a paclitaxel activity stimulation. Thus, in the presence of limonene, the epirubicin half-life increased from 46.2 min to 63 min, and from 6.2 min to 8.6 min in gemcitabine case, while for paclitaxel a decrease of half-life from 35.9 min to 25.8 min was determined. Therefore, certain drug-limonene interactions took place, leading to the emergence of molecular micro-assemblies impacting decomposition reaction of chemotherapeutics. To predict drug–limonene interactions, the Autodock 4.2.6 system was employed. Thus, two hydrophobic interactions and five π-alkyl interactions were established between EPR-LIM, the GCT-LIM connection involves four π-alkyl interactions, and the PTX-LIM bridges take place through three hydrophobic interactions and the one π-alkyl. Finally, the decomposition reaction mechanism of drugs was proposed.

Dried Blood Spot Technique Applied in Therapeutic Drug Monitoring of Anticancer Drugs: a Review on Conversion Methods to Correlate Plasma and Dried Blood Spot Concentrations

BACKGROUND

Anticancer drugs are notoriously characterized by a low therapeutic index, the introduction of therapeutic drug monitoring (TDM) in oncologic clinical practice could therefore be fundamental to improve treatment efficacy. In this context, an attractive technique to overcome the conventional venous sampling limits and simplify TDM application is represented by dried blood spot (DBS). Despite the significant progress made in bioanalysis exploiting DBS, there is still the need to tackle some challenges that limit the application of this technology: one of the main issues is the comparison of drug concentrations obtained from DBS with those obtained from reference matrix (e.g., plasma). In fact, the use of DBS assays to estimate plasma concentrations is highly dependent on the chemical-physical characteristics of the measured analyte, in particular on how these properties determine the drug partition in whole blood.

METHODS

In the present review, we introduce a critical investigation of the DBS-to-plasma concentration conversion methods proposed in the last ten years and applied to quantitative bioanalysis of anticancer drugs in DBS matrix. To prove the concordance between DBS and plasma concentration, the results of statistical tests applied and the presence or absence of trends or biases were also considered.

A comparison between two different dried blood substrates in determination of psychoactive substances in postmortem samples

Purpose

Whatman™ 903 cards represent a valid type of support for collection, storage, and analysis of dried blood spots (DBS). Whatman™ FTA (Flinders Technology Associates) are a type of cards soaked in chemicals that cause denaturation of proteins, while preserving DNA and ensuring the safe handling of DBS; to date, these cards are still rarely employed in forensic toxicology. The aim of this study was to analyze several psychoactive substances on not-dried blood on the two different cards and to compare the qualitative and quantitative results.

Methods

Twenty cardiac postmortem blood samples were collected and deposed on Whatman™ 903 and Whatman™ FTA cards. Spots and not-dried blood were analyzed following our validated and previously published liquid chromatography-mass spectrometry methods.

Results

We were able to identify: eight drugs of abuse and their metabolites (15 cases), five benzodiazepines and their metabolites (3 cases), six antidepressants (6 cases) and two antipsychotics (3 cases). We observed a perfect qualitative correspondence and a general good quantitative correlation between data obtained from not-dried blood and the two different DBS cards, except for alprazolam, diazepam, desmethyldiazepam, fluoxetine and sertraline, that showed a lower concentration on FTA. Additional experiments suggest that the chemicals, adsorbed on FTA, are not the cause of the loss of signal observed for the substances previously mentioned and that methanol should be preferred as extraction solvent.

Conclusions

This study proved that FTA cards are a good and a hazard-free alternative sample storage method for analysis of several psychoactive substances in postmortem blood.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11419-020-00567-2.

Technological advancement in dry blood matrix microsampling and its clinical relevance in quantitative drug analysis

In the past few decades, dried blood matrix biosampling has witnessed a marvelous interest among the researcher due to its user-friendly operation during blood sampling in preclinical and clinical applications. It also complies with the basic 3Rs (reduce, reuse and recycle) philosophy. Because of comparative simplicity, a huge number of researchers are paying attention to its technological advancements for widespread application in the bioanalysis and diagnosis arena. In this review, we have explained different approaches to be considered during dried blood matrix based microsampling including their clinical relevance in therapeutic drug monitoring. We have also discussed various strategies for avoiding and minimizing major unwanted analytical interferences associated with this technique during drug quantification. Further, various recent technological advancement in microsampling devices has been discussed correlating their clinical applications.

Electrostatic Intraperitoneal Aerosol Delivery of Nanoparticles: Proof of Concept and Preclinical Validation

There is an increasing interest in intraperitoneal delivery of chemotherapy as an aerosol in patients with peritoneal metastasis. The currently used technology is hampered by inhomogenous drug delivery throughout the peritoneal cavity because of gravity, drag, and inertial impaction. Addition of an electrical force to aerosol particles, exerted by an electrostatic field, can improve spatial aerosol homogeneity and enhance tissue penetration. A computational fluid dynamics model shows that electrostatic precipitation (EP) results in a significantly improved aerosol distribution. Fluorescent nanoparticles (NPs) remain stable after nebulization in vitro, while EP significantly improves spatial homogeneity of NP distribution. Next, pressurized intraperitoneal chemotherapy with and without EP using NP albumin bound paclitaxel (Nab-PTX) in a novel rat model is examined. EP does not worsen the effects of CO₂ insufflation and intraperitoneal Nab-PTX on mesothelial structural integrity or the severity of peritoneal inflammation. Importantly, EP significantly enhances tissue penetration of Nab-PTX in the anatomical regions not facing the nozzle of the nebulizer. Also, the addition of EP leads to more homogenous peritoneal tissue concentrations of Nab-PTX, in parallel with higher plasma concentrations. In conclusion, EP enhances spatial homogeneity and tissue uptake after intraperitoneal nebulization of anticancer NPs.

Barriers and opportunities for the clinical implementation of therapeutic drug monitoring in oncology

There are few fields of medicine in which the individualisation of medicines is more important than in the area of oncology. Under-dosing can have significant ramifications due to the potential for therapeutic failure and cancer progression; by contrast, over-dosing may lead to severe treatment-limiting side effects, such as agranulocytosis and neutropenia. Both circumstances lead to poor patient prognosis and contribute to the high mortality rates still seen in oncology. The concept of dose individualisation tailors dosing for each individual patient to ensure optimal drug exposure and best clinical outcomes. While the value of this strategy is well recognised, it has seen little translation to clinical application. However, it is important to recognise that the clinical setting of oncology is unlike that for which therapeutic drug monitoring (TDM) is currently the cornerstone of therapy (e.g. antimicrobials). Whilst there is much to learn from these established TDM settings, the challenges presented in the treatment of cancer must be considered to ensure the implementation of TDM in clinical practice. Recent advancements in a range of scientific disciplines have the capacity to address the current system limitations and significantly enhance the use of anticancer medicines to improve patient health. This review examines opportunities presented by these innovative scientific methodologies, specifically sampling strategies, bioanalytics and dosing decision support, to enable optimal practice and facilitate the clinical implementation of TDM in oncology.

Toward a better understanding of metabolic and pharmacokinetic characteristics of low-solubility, low-permeability natural medicines

Today, it is very challenging to develop new active pharmaceutical ingredients. Developing good preparations of well-recognized natural medicines is certainly a practical and economic strategy. Low-solubility, low-permeability natural medicines (LLNMs) possess valuable advantages such as effectiveness, relative low cost and low toxicity, which is shown by the presence of popular products on the market. Understanding the in vivo metabolic and pharmacokinetic characteristics of LLNMs contributes to overcoming their associated problems, such as low absorption and low bioavailability. In this review, the structure-based metabolic reactions of LLNMs and related enzymatic systems, cellular and bodily pharmacological effects and metabolic influences, drug-drug interactions involved in metabolism and microenvironmental changes, and pharmacokinetics and dose-dependent/linear pharmacokinetic models are comprehensively evaluated. This review suggests that better pharmacological activity and pharmacokinetic behaviors may be achieved by modifying the metabolism through using nanotechnology and nanosystem in combination with the suitable administration route and dosage. It is noteworthy that novel nanosystems, such as triggered-release liposomes, nucleic acid polymer nanosystems and PEGylated dendrimers, in addition to prodrug and intestinal penetration enhancer, demonstrate encouraging performance. Insights into the metabolic and pharmacokinetic characteristics of LLNMs may help pharmacists to identify new LLNM formulations with high bioavailability and amazing efficacy and help physicians carry out LLNM-based precision medicine and individualized therapies.

Preclinical evaluation of local prolonged release of paclitaxel from gelatin microspheres for the prevention of recurrence of peritoneal carcinomatosis in advanced ovarian cancer

Patients with advanced ovarian cancer develop recurrence despite initial treatment response to standard treatment of surgery and intravenous/intraperitoneal (IP) chemotherapy, partly due to a limited peritoneal exposure time of chemotherapeutics. Paclitaxel-loaded genipin-crosslinked gelatin microspheres (PTX-GP-MS) are evaluated for the treatment of microscopic peritoneal carcinomatosis and prevention of recurrent disease. The highest drug load (39.2 µg PTX/mg MS) was obtained by immersion of GP-MS in aqueous PTX nanosuspension (PTXnano-GP-MS) instead of ethanolic PTX solution (PTXEtOH-GP-MS). PTX release from PTX-GP-MS was prolonged. PTXnano-GP-MS displayed a more controlled release compared to a biphasic release from PTXEtOH-GP-MS. Anticancer efficacy of IP PTX-GP-MS (PTXEtOH-GP-MS, D = 7.5 mg PTX/kg; PTXnano-GP-MS D = 7.5 and 35 mg PTX/kg), IP nanoparticular albumin-bound PTX (D = 35 mg PTX/kg) and controls (0.9% NaCl, blank GP-MS) was evaluated in a microscopic peritoneal carcinomatosis xenograft mouse model. PTXnano-GP-MS showed superior anticancer efficacy with significant increased survival time, decreased peritoneal carcinomatosis index score and ascites incidence. However, prolonged PTX release over 14 days from PTXnano-GP-MS caused drug-related toxicity in 27% of high-dosed PTXnano-GP-MS-treated mice. Dose simulations for PTXnano-GP-MS demonstrated an optimal survival without drug-induced toxicity in a range of 7.5-15 mg PTX/kg. Low-dosed PTXnano-GP-MS can be a promising IP drug delivery system to prevent recurrent ovarian cancer.

Simultaneous determination of cardiovascular drugs in dried blood spot by liquid chromatography-tandem mass spectrometry

A dried blood spot (DBS) sampling method was exploited to extract cardiovascular drugs using a small volume of whole blood of human and rodent. Thereafter, an analytical method using liquid chromatography with tandem mass spectrometry (LC-MS/MS) was developed and validated for the determination of 12 cardiovascular drugs. A 6 mm internal diameter disc containing 10 μL of blood was punched from a specifically designed card and analyzed by LC-MS/MS using a gradient elution method with a total run time of 16 min. For sample separation, a universal octadecyl-silica column was used with a flow rate of 0.2 mL/ min. The developed method was validated in terms of linearity, accuracy, and precision, which showed satisfactory results. In addition, the matrix effects were closely investigated to confirm the extraction efficiency. Additionally, the stability was tested by storing DBSs at room temperature; the results showed that these drugs were stable for at least 30 days. Accordingly, the proposed LC-MS/MS method is capable to analyze several cardiovascular drugs in a single analysis. It can be applied to therapeutic drug monitoring in patients as well as in the in vivo settings.

Efficient production of polysaccharide by Chaetomium globosum CGMCC 6882 through co-culture with host plant Gynostemma pentaphyllum

Endophytic fungus, as a new kind of microbial resources and separated from plants, has attracted increasing attention due to its ability to synthesize the same or similar bioactive secondary metabolites as the host plants. Nevertheless, the effects of the symbiotic relationship between microorganisms and elicitors existed in host plant on metabolite production are not adequately understood. In the present work, the impacts of elicitors (ginseng saponin and puerarin) and symbiotic microorganisms on endophytic fungus Chaetomium globosum CGMCC 6882 synthesizing polysaccharide were evaluated. Results show that the polysaccharide titers increased from 2.36 to 3.88 g/L and 3.67 g/L with the addition of 16 μg/L ginseng saponin and puerarin, respectively. Moreover, the maximum polysaccharide titer reached 4.55 g/L when C. globosum CGMCC 6882 was co-cultured with UV-irradiated G. pentaphyllum. This work brings a significant contribution to the research and interpretation of the relationship between endophytic fungus and its host plant.

Bioanalytical method validation: new FDA guidance vs. EMA guideline. Better or worse?

Bioanalysis concerns the identification and quantification of analytes in various biological matrices. Validation of any analytical method helps to achieve reliable results that are necessary for proper decisions on drug dosing and patient safety. In the case of bioanalytical methods, validation additionally covers steps of pharmacokinetic and toxicological studies - such as sample collection, handling, shipment, storage, and preparation. We drew our attention to the difference of both the newest FDA Guidance and the EMA Guideline on bioanalytical method validation. We aimed to point out advantages of both documents from the laboratory perspective. The FDA and the EMA documents are similar, but not identical. The EMA describes the practical conduct of experiments more precisely, while the FDA presents reporting recommendations more comprehensively. There are also differences in recommended validation parameters. We hope that the International Council for Harmonisation will combine advantages of both documents to avoid confusing differences in terminology as well as the unnecessary effort of being compliant with two or more guidelines.

Antibacterial activity of a polysaccharide produced from Chaetomium globosum CGMCC 6882

In present work, a polysaccharide (GCP) was produced by Chaetomium globosum CGMCC 6882 and characterized. GCP was composed of arabinose, galactose, glucose, xylose, mannose and glucuronic acid in a molar ratio of 0.64: 2.58: 23.53: 0.90: 2.47: 0.27 with molecular weight of 8.093 × 10⁴ Da and polydispersity (Mw/Mn) of 1.014. Antibacterial characteristics and mechanism of GCP against Escherichia coli and Staphlococcus aureus were investigated by analysis of inhibition zones, minimum inhibitory concentration (MIC), alkaline phosphatase and β-galactosidase activities, electrical conductivity and bacterial morphology. Results showed that the MIC of GCP against E. coli and S. aureus were 1.75 mg/mL and 0.67 mg/mL, respectively. Moreover, GCP exerted antibacterial activities by disrupting the inner membrane and increasing the cell permeability, but had no influences on cell wall. This work indicated that GCP could be explored as a promising antibacterial agent in food and pharmaceutical industries.

Current development in the formulations of non-injection administration of paclitaxel

Paclitaxel (PTX) belongs to a class of taxane anti-tumor drug used for the clinic treatment of breast cancer, ovarian cancer, non-small-cell lung cancer, and so on. PTX has poor water solubility and oral bioavailability. It is generally administered via intravenous (i.v.) infusion. Traditional PTX injectable preparations contain Cremophor-EL and ethanol to improve its solubility, which would result in adverse reactions like severe hypersensitivity, neutropenia, etc. Adverse reactions can be reduced only by complicated pretreatment with glucocorticoid and antihistamines drugs and followed by PTX slow infusion for three hours, which has brought significant inconvenience to the patients. Though, a new-generation PTX formulation, Abraxane, free of Cremophor-EL and ethanol, is still being administrated by frequent i.v. infusions and extremely expensive. Therefore, non-injection administration of PTX is urgently needed to avoid the side effects as well as reduce inconvenience to the patients. Recently, a variety of non-injection drug delivery systems (DDSs) of PTX have been developed. This review aims to discuss the progress of non-injectable administration systems of PTX, including oral administration systems, vaginal administration systems, implantable DDSs, transdermal DDSs and intranasal administration for the future study and clinical applications.