1
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Liu F, Hutchinson R. Visible particles in parenteral drug products: A review of current safety assessment practice. Curr Res Toxicol 2024; 7:100175. [PMID: 38975062 PMCID: PMC11223083 DOI: 10.1016/j.crtox.2024.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Parenteral drug products (PDPs) are administered extensively to treat various diseases. Product quality plays a critical role in ensuring patient safety and product efficacy. One important quality challenge is the contamination of particles in PDPs. Particle presence in PDPs represents potential safety risk to patients. Differential guidance and practice have been in place for visible (VPs) and subvisible particles (SVPs) in PDPs. For SVPs, the amount limits have been harmonized in multiple Pharmacopeias. The pharmaceutical industry follows the guided limits for regulatory and quality compliance. However, for VPs, no such acceptable limit has been set. This results in not only quality but also safety challenges for manufacturers and drug developers in managing and evaluating VPs. It is important to understand the potential safety risk of VPs so these can be weighed against the benefit of the PDPs. To evaluate their potential risk(s), it is necessary to understand their nature, origin, frequency of their occurrence, safety risk, the risk mitigation measures, and the method to evaluate their safety. The current paper reviews the critical literature on these aspects and provides insight into considerations when performing safety assessment and managing the risk(s) for VPs in PDPs.
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Affiliation(s)
- Frank Liu
- Safe Product Services LLC, Pittsfield, MA, USA
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2
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Sehner C, Bernier T, Blum K, Clemann N, Glogovac M, Hawkins WA, Kohan M, Linker F, Lovsin-Barle E, Osadolor O, Pfister T, Schulze E, Schwind M, Tuschl G, Wiesner L. Comparison of permitted daily exposure (PDE) values for active pharmaceutical ingredients (APIs) - Evidence of a robust approach. Regul Toxicol Pharmacol 2024; 150:105649. [PMID: 38782234 DOI: 10.1016/j.yrtph.2024.105649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/20/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Permitted Daily Exposure Limits (PDEs) are set for Active Pharmaceutical Ingredients (APIs) to control cross-contamination when manufacturing medicinal products in shared facilities. With the lack of official PDE lists for pharmaceuticals, PDEs have to be set by each company separately. Although general rules and guidelines for the setting of PDEs exist, inter-company variations in the setting of PDEs occur and are considered acceptable within a certain range. To evaluate the robustness of the PDE approach between different pharmaceutical companies, data on PDE setting of five marketed APIs (amlodipine, hydrochlorothiazide, metformin, morphine, and omeprazole) were collected and compared. Findings show that the variability between PDE values is within acceptable ranges (below 10-fold) for all compounds, with the highest difference for morphine due to different Point of Departures (PODs) and Adjustment Factors (AFs). Factors of PDE variability identified and further discussed are: (1) availability of data, (2) selection of POD, (3) assignment of AFs, (4) route-to-route extrapolation, and (5) expert judgement and differences in company policies. We conclude that the investigated PDE methods and calculations are robust and scientifically defensible. Additionally, we provide further recommendations to harmonize PDE calculation approaches across the pharmaceutical industry.
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Affiliation(s)
- Claudia Sehner
- Boehringer Ingelheim Pharma GmbH & Co. KG, 88397, Biberach, Germany.
| | - Tanja Bernier
- Abbott Laboratories GmbH, 31535, Neustadt Am Rübenberge, Germany
| | - Kamila Blum
- GlaxoSmithKline, Prinzregentenplatz 9, 81675, Munich, Germany
| | | | | | - William A Hawkins
- SafeBridge Europe Ltd., 33 St Andrews Street South, Bury St Edmunds, IP33 3PH, Suffolk, United Kingdom
| | - Martin Kohan
- SafeBridge Europe Ltd., 33 St Andrews Street South, Bury St Edmunds, IP33 3PH, Suffolk, United Kingdom
| | - Fenneke Linker
- Grünenthal GmbH, Zieglerstraße 6, 52078, Aachen, Germany
| | | | - Osahon Osadolor
- AstraZeneca, Francis Crick Avenue, Cambridge, United Kingdom
| | | | - Elisa Schulze
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Markus Schwind
- Sanofi-Aventis Deutschland GmbH, 65926, Frankfurt, Germany
| | - Gregor Tuschl
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Lisa Wiesner
- Takeda Pharmaceuticals International AG, Glattpark-Opfikon, Switzerland
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3
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Conti M, Boland D, Heeran C, Symington JA, Pullen JR, Dimartino S. Purification of monoclonal antibodies using novel 3D printed ordered stationary phases. J Chromatogr A 2024; 1722:464873. [PMID: 38626540 DOI: 10.1016/j.chroma.2024.464873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
3D printing offers the unprecedented ability to fabricate chromatography stationary phases with bespoke 3D morphology as opposed to traditional packed beds of spherical beads. The restricted range of printable materials compatible with chromatography is considered a setback for its industrial implementation. Recently, we proposed a novel ink that exhibits favourable printing performance (printing time ∼100 mL/h, resolution ∼200 µm) and broadens the possibilities for a range of chromatography applications thanks to its customisable surface chemistry. In this work, this ink was used to fabricate 3D printed ordered columns with 300 µm channels for the capture and polishing of therapeutic monoclonal antibodies. The columns were initially assessed for leachables and extractables, revealing no material propensity for leaching. Columns were then functionalised with protein A and SO3 ligands to obtain affinity and strong cation exchangers, respectively. 3D printed protein A columns showed >85 % IgG recovery from harvested cell culture fluid with purities above 98 %. Column reusability was evaluated over 20 cycles showing unaffected performance. Eluate samples were analysed for co-eluted protein A fragments, host cell protein and aggregates. Results demonstrate excellent HCP clearance (logarithmic reduction value of > 2.5) and protein A leakage in the range of commercial affinity resins (<100 ng/mg). SO3 functionalised columns employed for polishing achieved removal of leaked Protein A (down to 10 ng/mg) to meet regulatory expectations of product purity. This work is the first implementation of 3D printed columns for mAb purification and provides strong evidence for their potential in industrial bioseparations.
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Affiliation(s)
- Mariachiara Conti
- Institute for Bioengineering, The School of Engineering, The University of Edinburgh, Edinburgh, EH9 3DW, UK
| | - Deirdre Boland
- Fujifilm Diosynth Biotechnologies, Teesside, TS23 1LH, UK
| | - Carmen Heeran
- Fujifilm Diosynth Biotechnologies, Teesside, TS23 1LH, UK
| | | | - James R Pullen
- Fujifilm Diosynth Biotechnologies, Teesside, TS23 1LH, UK
| | - Simone Dimartino
- Institute for Bioengineering, The School of Engineering, The University of Edinburgh, Edinburgh, EH9 3DW, UK.
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4
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Pahl I, Pahl A, Hauk A, Budde D, Sievers S, Fruth L, Menzel R. Assessing biologic/toxicologic effects of extractables from plastic contact materials for advanced therapy manufacturing using cell painting assay and cytotoxicity screening. Sci Rep 2024; 14:5933. [PMID: 38467674 PMCID: PMC10928227 DOI: 10.1038/s41598-024-55952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
Plastic components are essential in the pharmaceutical industry, encompassing container closure systems, laboratory handling equipment, and single-use systems. As part of their material qualification process, studies on interactions between plastic contact materials and process solutions or drug products are conducted. The assessment of single-use systems includes their potential impact on patient safety, product quality, and process performance. This is particularly crucial in cell and gene therapy applications since interactions with the plastic contact material may result in an adverse effect on the isolated therapeutic human cells. We utilized the cell painting assay (CPA), a non-targeted method, for profiling the morphological characteristics of U2OS human osteosarcoma cells in contact with chemicals related to plastic contact materials. Specifically, we conducted a comprehensive analysis of 45 common plastic extractables, and two extracts from single-use systems. Results of the CPA are compared with a standard cytotoxicity assay, an osteogenesis differentiation assay, and in silico toxicity predictions. The findings of this feasibility study demonstrate that the device extracts and most of the tested compounds do not evoke any measurable biological changes on the cells (induction ≤ 5%) among the 579 cell features measured at concentrations ≤ 50 µM. CPA can serve as an important assay to reveal unique information not accessible through quantitative structure-activity relationship analysis and vice versa. The results highlight the need for a combination of in vitro and in silico methods in a comprehensive assessment of single-use equipment utilized in advanced therapy medicinal products manufacturing.
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Affiliation(s)
- Ina Pahl
- Sartorius Stedim Biotech GmbH, August-Spindler-Str. 11, 37079, Göttingen, Germany.
| | - Axel Pahl
- Compound Management and Screening Center, MPI of Molecular Physiology, Otto-Hahn-Str. 11, 44227, Dortmund, Germany
| | - Armin Hauk
- Sartorius Stedim Biotech GmbH, August-Spindler-Str. 11, 37079, Göttingen, Germany
| | - Dana Budde
- Sartorius Stedim Biotech GmbH, August-Spindler-Str. 11, 37079, Göttingen, Germany
| | - Sonja Sievers
- Compound Management and Screening Center, MPI of Molecular Physiology, Otto-Hahn-Str. 11, 44227, Dortmund, Germany
| | - Lothar Fruth
- Tox Expert GmbH, An der Feldscheide 1, 37083, Göttingen, Germany
| | - Roberto Menzel
- Sartorius Stedim Biotech GmbH, August-Spindler-Str. 11, 37079, Göttingen, Germany
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5
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Arroyo A, Booij P, Woldemariam G, Bruen U, Creasey J, Stanard B, Parris P, Nagao L, Bielinski MK. Cell and Gene Therapies: Challenges in Designing Extractables and Leachables Studies and Conducting Safety Assessments. J Pharm Sci 2024; 113:513-522. [PMID: 38176455 DOI: 10.1016/j.xphs.2023.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
Over the past decade, Cell and Gene Therapies (C>) have been an emerging therapeutic area with more than twenty C> drug products approved and over 1000 registered trials. The remarkable progress in these modalities brings new challenges for scientists who evaluate manufacturing and storage materials, including risk assessments for extractables and leachables (E&L). Establishing a business process to qualify materials for these applications is an important risk mitigation strategy in support of these assessments. Process validation verifying process performance and product quality requirements using qualified materials also ensures that leachables from the materials do not result in an impact to process and product. The authors provide an overview of available guidelines and publications relevant to E&L risk assessments that can be used to support ex vivo C> products, highlighting gaps and standardization needs in the areas of biocompatibility and extractables conditions. Finally, the authors present leachable testing strategies, relevant to the specific manufacturing and storage conditions of C> products, and safety assessment considerations for organic and inorganic chemical entities.
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Affiliation(s)
- Adeyma Arroyo
- Genentech, Inc., a member of the Roche Group, South San Francisco, CA 94080, USA
| | | | | | - Uma Bruen
- Organon, LLC., Jersey City, NJ 07302, USA
| | | | - Brad Stanard
- Ultragenyx Pharmaceutical Inc., Novato, CA 94949, USA
| | - Patricia Parris
- Pfizer Worldwide Research, Development and Medical, Kent, UK
| | - Lee Nagao
- Faegre Drinker Biddle & Reath LLP, Washington, DC, 20005, USA
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6
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Ulrich N, Böhme A, Strobel AB, Egert T. Predicting partitioning from low density polyethylene to blood and adipose tissue by linear solvation energy relationship models. J Biomed Mater Res B Appl Biomater 2023; 111:2044-2054. [PMID: 37498141 DOI: 10.1002/jbm.b.35304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/15/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
The variety of polymers utilized in medical devices demands for testing of extractables and leachables according to ISO 10993-18:2020 in combination with ISO 10993-1:2018. The extraction of the materials involves the use of organic solvents as well as aqueous buffers to cover a wide range of polarity and pH-values, respectively. To estimate patient exposure to chemicals leaching from a polymer in direct body contact, simulating solvents are applied to best mimic the solubilization and partitioning behavior of the related tissue or body fluid. Here we apply linear solvation energy relationship (LSER) models to predict blood/water and adipose tissue/water partition coefficients. We suggest this predictive approach to project levels of potential leachables, design extraction experiments, and to identify the optimal composition of simulating extraction solvents. We compare our predictions to LSER predictions for commonly applied surrogates like ethanol/water mixtures, butanol, and octanol as well as olive oil, butanone, 1,4-dioxane for blood and adipose tissue, respectively. We therefore selected a set of 26 experimentally determined blood/water partition coefficients and 33 adipose tissue/water partition coefficients, where we demonstrate that based on the root mean squared error rmse the LSER approach performs better than surrogates like octanol or butanol and equally well as 60:40 ethanol/water for blood. For adipose tissue/water partitioning, the experimentally determined octanol/water partition coefficient performs best but the rmse is at the same range as our LSER approach based on experimentally determined descriptors. Further, we applied our approach for 248 extractables where we calculated blood/low density polyethylene (LDPE) and adipose tissue/LDPE partition coefficients. By this approach, we successfully identified chemicals of potential interest to a toxicological evaluation based on the total risk score.
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Affiliation(s)
- Nadin Ulrich
- Department of Ecological Chemistry, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Alexander Böhme
- Department of Ecological Chemistry, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | | | - Thomas Egert
- Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany
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7
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Masuda-Herrera M, Rosen HT, Burild A, Broschard T, Bell T, Graham J, Griffin T, Hillegass J, Leavitt P, Huta B, Parris P, Bruen U, Cruz M, Bercu J. Harmonisation of read-across methodology for drug substance extractables and leachables (E&Ls). Regul Toxicol Pharmacol 2023; 145:105494. [PMID: 37748702 DOI: 10.1016/j.yrtph.2023.105494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
Health-based exposure limits (HBELs) are derived for leachables from polymeric components that interact with the drug substance which exceed a safety concern threshold (SCT). However, given the nature of leachables, there is not always chemical-specific toxicology data. Read-across methodology specific to extractables and leachables (E&Ls) was developed based on survey data collected from 11 pharmaceutical companies and methodology used in other industries. One additional challenge for E&L read-across is most toxicology data is from the oral route of administration, whereas the parenteral route is very common for the leachable HBEL derivation. A conservative framework was developed to estimate oral bioavailability and the corresponding oral to parenteral extrapolation factor using physical chemical data. When this conservative framework was tested against 73 compounds with oral bioavailability data, it was found that the predicted bioavailability based on physico-chemical properties was conservatively greater than or equal to the experimental bioavailability 79% of the time. In conclusion, an E&L read-across methodology has been developed to provide a consistent, health protective framework for deriving HBELs when toxicology data is limited.
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Affiliation(s)
- Melisa Masuda-Herrera
- Gilead Sciences, Inc., Nonclinical Safety and Pathobiology (NSP), Foster City, CA, 94404, USA.
| | - Hannah T Rosen
- University of California Berkeley, Nutritional Sciences and Toxicology, Berkeley, CA, 94720, USA
| | - Anders Burild
- Novo Nordisk A/S, Safety Sciences, Imaging and Data Management, Novo Nordisk Park, 2760, Måløv, Denmark
| | - Thomas Broschard
- Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Tyler Bell
- Takeda Pharmaceutical Co., Rochester, NY, USA
| | - Jessica Graham
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Troy Griffin
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, 19380, USA
| | - Jedd Hillegass
- Bristol Myers Squibb, 1 Squibb Drive, New Brunswick, NJ, 08903, USA
| | - Penny Leavitt
- Bristol Myers Squibb, 1 Squibb Drive, New Brunswick, NJ, 08903, USA
| | - Brian Huta
- Pfizer Worldwide Research and Development, Sandwich, UK
| | | | - Uma Bruen
- Organon, LLC., Jersey City, NJ, 07302, USA
| | - Maureen Cruz
- Faegre Drinker Biddle & Reath LLP, Washington, DC, USA
| | - Joel Bercu
- Gilead Sciences, Inc., Nonclinical Safety and Pathobiology (NSP), Foster City, CA, 94404, USA
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8
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Bello W, Pezzatti J, Berger-Gryllaki M, Rudaz S, Sadeghipour F. Development of a generic approach for monitoring leachable compounds in hospital pharmacy-prepared prefilled plastic packaging by ultrahigh-performance liquid chromatography coupled to high-resolution mass spectrometry with postcolumn infusion. J Pharm Biomed Anal 2023; 236:115640. [PMID: 37683372 DOI: 10.1016/j.jpba.2023.115640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/31/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
Prefilled plastic packaging is time- and cost-effective in hospital pharmacy because it prevents waste, preparation errors, dosage errors, microbial contamination and accidents. This packaging mostly includes prefilled syringes (PFS), intravenous (IV) bags and vials intended for long-term storage that can be used for immediate treatment. There is a rising availability in the market for prefilled drug products due to their practical approach. Leachable compounds could be evaluated in hospital pharmacy-prepared prefilled drug solutions. The Pharmacy Department at the Lausanne University Hospital has developed an innovative, highly sensitive, and generic method by postcolumn infusion based on ultrahigh-performance liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) for the analysis of plastic additives in hospital pharmacies. The postcolumn infusion solution was developed with 2% ammonium hydroxide in methanol on a representative set of 30 candidate compounds with different physical-chemical properties, such as log P and molecular structure, to represent the most important categories of additives. The LODs obtained for all compounds ranged from 0.03 to 7.91 ng/mL with linearity up to 250 ng/mL. Through this screening method, plastic additives can be rapidly identified due to the combined use of retention time, exact mass (including isotopic pattern) and MS/MS spectra. In addition, the users can screen for vast categories of plastic additives, including plasticizers, epoxy monomers, antioxidants, UV stabilizers, and others. The screening is facilitated by assessments of a complex in-house-built database for extractable and leachable trace assessment (DELTA), containing 205 compounds for unambiguous identification. Relative response factors were established for all analytes to obtain a semiquantitation of compounds. Moreover, the database also contains valuable estimative toxicology information, which was obtained through calculating their permissible dose exposure threshold; thus, estimative toxicology assessment can be performed for identified compounds in prefilled drug products. This method and the database were applied to a hospital pharmacy-prepared prefilled vancomycin syringe for paediatric use. Ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) was used to prepare the samples for leachable analysis. As a result, 17 plastic additives were formally identified, and their concentrations were estimated. A toxicology assessment was performed by comparing their concentrations with their theoretical PDE thresholds. In conclusion, the prefilled drug solution released a negligible amount of known leachables that appeared to be safe for use in neonates and children.
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Affiliation(s)
- William Bello
- Pharmacy Department, Lausanne University Hospital, Switzerland; Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, CMU-Rue Michel Servet 1, 1211 Geneva 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-Rue Michel Servet 1, 1211 Geneva 4, Switzerland
| | - Julian Pezzatti
- Pharmacy Department, Lausanne University Hospital, Switzerland
| | | | - Serge Rudaz
- School of Pharmaceutical Sciences, University of Geneva, CMU-Rue Michel Servet 1, 1211 Geneva 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-Rue Michel Servet 1, 1211 Geneva 4, Switzerland; Swiss Center of Applied Human Toxicology (SCAHT), Basel, Switzerland
| | - Farshid Sadeghipour
- Pharmacy Department, Lausanne University Hospital, Switzerland; Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, CMU-Rue Michel Servet 1, 1211 Geneva 4, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-Rue Michel Servet 1, 1211 Geneva 4, Switzerland.
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9
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Vitharana S, Stillahn JM, Katayama DS, Henry CS, Manning MC. Application of Formulation Principles to Stability Issues Encountered During Processing, Manufacturing, and Storage of Drug Substance and Drug Product Protein Therapeutics. J Pharm Sci 2023; 112:2724-2751. [PMID: 37572779 DOI: 10.1016/j.xphs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
The field of formulation and stabilization of protein therapeutics has become rather extensive. However, most of the focus has been on stabilization of the final drug product. Yet, proteins experience stress and degradation through the manufacturing process, starting with fermentaition. This review describes how formulation principles can be applied to stabilize biopharmaceutical proteins during bioprocessing and manufacturing, considering each unit operation involved in prepration of the drug substance. In addition, the impact of the container on stabilty is discussed as well.
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Affiliation(s)
| | - Joshua M Stillahn
- Legacy BioDesign LLC, Johnstown, CO 80534, USA; Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA
| | | | - Charles S Henry
- Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA
| | - Mark Cornell Manning
- Legacy BioDesign LLC, Johnstown, CO 80534, USA; Department of Chemistry, Colorado State University, Fort Collins, CO 80523, USA.
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10
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Smith C, Lyndon M, Jeong L, Lehman D, Jameson JB, Chevva H, Ayala-Fierro F, Cook D, Carter K, Oldham M, Gillman IG. Analytical approaches for the evaluation of data deficient simulated leachable compounds in ENDS products: a case study. Front Chem 2023; 11:1212744. [PMID: 37601911 PMCID: PMC10436322 DOI: 10.3389/fchem.2023.1212744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Leachable investigations are routinely undertaken across a range of sectors (e.g., pharmaceuticals, medical devices, etc.) to determine whether chemicals from a container closure system transfer into a product under normal conditions of use. For Electronic Nicotine Delivery Systems (ENDS) the container closure system includes all materials in contact with the e-liquid that is aerosolized and subsequently inhaled by the user. Currently, there is no guidance for conducting leachable studies for ENDS products, however, there are relevant guidance documents for orally inhaled drug products that can be applied to an ENDS container closure system. We present a case study of the analytical investigation of two leachable compounds identified in simulated leachable studies using aged JUULpods filled with unflavored e-liquid (PG/VG/nicotine/benzoic acid). Both compounds had limited toxicological information and were considered data deficient. A qualitative analysis of the aerosol collected from aged commercial JUULpods (Virginia Tobacco and Menthol), using a similar analytical method (LC-MS/MS) used in the simulated leachable studies, showed no trace or detectable levels of either leachable compound. Therefore, this qualitative analysis did not provide semi-quantitative values for the data-deficient leachable compounds necessary to support toxicological risk assessment. Further, no commercial authentic standards or reasonable synthetic route were available due to the molecular size and structural complexity of the compounds. Instead, method limits were established using an alternative approach to standard ICH guidelines. The experimentally determined method limit of quantitation, using spiked samples of simulated leachable e-liquid, provided conservative semi-quantitative values for each data deficient leachable compound in the aerosol that enabled a transfer efficiency from e-liquid to aerosol to be estimated. The transfer efficiency of each leachable compound was experimentally determined to be less than 2% based on the limit of quantitation, which then could be used to define a relevant exposure limit for the toxicological risk assessment. This work details a novel analytical approach for determining the transfer efficiency of data deficient leachable compounds from ENDS container closure systems into the ENDS aerosol to support toxicological health risk assessments.
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11
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Fu C, Zhang X, Lei S, Zou M, Wang L, Jiao J, Yang Q. Identification and quantification of extractables and leachables in laminated film and pouches for pharmaceutical packaging. J Pharm Biomed Anal 2022; 220:115015. [PMID: 36054946 DOI: 10.1016/j.jpba.2022.115015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022]
Abstract
Extractables and leachables from pharmaceutical packaging material can potentially be detrimental, which may affect the safety of the drug products. In this study, two compounds were found to be the possible extractables from the secondary packaging material. A strategy combining high performance liquid chromatography (HPLC), fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) and nuclear magnetic resonance (NMR) spectroscopy was utilized for identification of the two compounds. Afterwards, a simple and sensitive HPLC method was developed and validated for the simultaneous quantification of both. The results indicated that this method was suitable for quantificating the two extractables in the pharmaceutical packaging material.
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Affiliation(s)
- Chunwang Fu
- Shenyang Xingqi Pharmaceutical Co., Ltd., Shenyang 110163, China
| | - Xiaoxue Zhang
- Shenyang Xingqi Pharmaceutical Co., Ltd., Shenyang 110163, China
| | - Shuo Lei
- Shenyang Xingqi Pharmaceutical Co., Ltd., Shenyang 110163, China
| | - Mengyu Zou
- Shenyang Xingqi Pharmaceutical Co., Ltd., Shenyang 110163, China
| | - Liang Wang
- Shenyang Xingqi Pharmaceutical Co., Ltd., Shenyang 110163, China
| | - Jian Jiao
- Department of Pharmacy, General Hospital of Northern Theater Command, No.5, Guangrong Street, Heping District, Shenyang 110000, China.
| | - Qiang Yang
- Shenyang Xingqi Pharmaceutical Co., Ltd., Shenyang 110163, China.
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12
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Parris P, Whelan G, Burild A, Whritenour J, Bruen U, Bercu J, Callis C, Graham J, Johann E, Griffin T, Kohan M, Martin EA, Masuda-Herrera M, Stanard B, Tien E, Cruz M, Nagao L. Framework for sensitization assessment of extractables and leachables in pharmaceuticals. Crit Rev Toxicol 2022; 52:125-138. [PMID: 35703156 DOI: 10.1080/10408444.2022.2065966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
During the toxicological assessment of extractables and leachables in drug products, localized hazards such as irritation or sensitization may be identified. Typically, because of the low concentration at which leachables occur in pharmaceuticals, irritation is of minimal concern; therefore, this manuscript focuses on sensitization potential. The primary objective of performing a leachable sensitization assessment is protection against Type IV induction of sensitization, rather than prevention of an elicitation response, as it is not possible to account for the immunological state of every individual. Sensitizers have a wide range of potencies and those which induce sensitization upon exposure at a low concentration (i.e. strong, or extreme sensitizers) pose the highest risk to patients and should be the focus of the risk assessment. The Extractables and Leachables Safety Information Exchange (ELSIE) consortium has reviewed the status of dermal, respiratory, and systemic risk assessment in cosmetic and pharmaceutical industries, and proposes a framework to evaluate the safety of known or potential dermal sensitizers in pharmaceuticals. Due to the lack of specific regulatory guidance on this topic, the science-driven risk-based approach proposed by ELSIE encourages consistency in the toxicological assessment of extractables and leachables to maintain high product quality and ensure patient safety.
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Affiliation(s)
- Patricia Parris
- Pfizer Worldwide Research, Development and Medical, Kent, UK
| | | | - Anders Burild
- Novo Nordisk A/S, Safety Sciences, Imaging and Data Management, Måløv, Denmark
| | | | - Uma Bruen
- Organon USA Inc., Jersey City, NJ, USA
| | - Joel Bercu
- Gilead Sciences Inc., Foster City, CA, USA
| | - Courtney Callis
- Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, IN, USA
| | | | | | - Troy Griffin
- Teva Branded Pharmaceutical Products R&D, West Chester, PA, USA
| | - Martin Kohan
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | - Elizabeth A Martin
- Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, UK
| | | | | | | | - Maureen Cruz
- Faegre Drinker Biddle & Reath LLP, Washington, DC, USA
| | - Lee Nagao
- Faegre Drinker Biddle & Reath LLP, Washington, DC, USA
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Evaluation of Two Cosolvency Models to Predict Solute Partitioning between Polymers (LDPE) and Water - Ethanol Simulating Solvent Mixtures. Pharm Res 2022; 39:733-751. [PMID: 35352279 DOI: 10.1007/s11095-022-03210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Binary water - ethanol mixtures, by mimicking a clinically relevant medium's polarity-driven extraction strength, facilitate experimental modeling of patient exposure to chemicals which can potentially leach from a plastic material for pharmaceutical applications. Estimates of patient exposure could consequently benefit from a quantitative concept for tailoring the extraction strength of the simulating solvent mixture towards the one of the clinically relevant medium. METHODS The hypothetical partition coefficient based upon the differential solubility between water-ethanol mixtures and water, [Formula: see text], has been calculated by the log-linear model from Yalkowsky and coworkers and a cosolvency model based on Abraham-type linear solvation energy relationships (LSERs). Then, by applying a thermodynamic cycle using the partition coefficient LDPE/water, [Formula: see text], partitioning between LDPE and the ethanol in water mixture was calculated and experimentally verified for a wide array of chemically diverse solutes. RESULTS The partition coefficients between LDPE and volume fractions of 0.1, 0.2, 0.35 and 0.5 of ethanol in water calculated by this approach correlated well with experimentally obtained values. The LSER based model was found slightly superior over the log-linear cosolvency model. CONCLUSIONS Solubilization strength projection by means of cosolvency models in combination with LSER predicted partition coefficients LDPE/water enable the tailored preparation of water-ethanol simulating solvent mixtures when input parameters from the clinically relevant medium are available. This approach can increase the reliability of patient exposure estimations and avoid overly complex extraction profiles, thus minimizing time and resources for chemical safety risk assessments on plastic materials used in pharmaceutical applications.
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14
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Reddy RE, Hu W, Lowry BR, Fogle JL, Malick RE, Erexson G, Westerberg JM, Carragher AL, Robinson EE, Orihuela CA, Hillier MC, Davis SR, Kruk PE, Ide ND, Mlinar L, Mulhern MM, Engstrom KM, Chaaya E, McKee LA, Manning PE, Tirino P, Joudioux R, Cornelio L. Risk Assessment of the Leachables’ Profile for Small-Molecule Pharmaceutical Drug Substances. Org Process Res Dev 2021. [DOI: 10.1021/acs.oprd.1c00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rajarathnam E. Reddy
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Wenbin Hu
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Brian R. Lowry
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Jace L. Fogle
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Robert E. Malick
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Greg Erexson
- Preclinical Safety, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - John M. Westerberg
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Adelia L. Carragher
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Emily E. Robinson
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Carlos A. Orihuela
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Michael C. Hillier
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Steven R. Davis
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Paul E. Kruk
- Operations Science and Technology, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Nathan D. Ide
- Process Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Laurie Mlinar
- Process Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Mathew M. Mulhern
- Process Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Kenneth M. Engstrom
- Process Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Elie Chaaya
- Operations Manufacturing and Engineering, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Laura A. McKee
- Process Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Patrick E. Manning
- Process Research and Development, AbbVie Inc., 1 North Waukegan Road, North Chicago, Illinois 60064, United States
| | - Pasquale Tirino
- Manufacturing Science and Technology, AbbVie s.r.l., S.R. 148 Pontina Km 52 snc, Campoverde di Aprilia, Latino 04011, Italy
| | - Roberta Joudioux
- Manufacturing Science and Technology, AbbVie s.r.l., S.R. 148 Pontina Km 52 snc, Campoverde di Aprilia, Latino 04011, Italy
| | - Lisa Cornelio
- Manufacturing Science and Technology, AbbVie s.r.l., S.R. 148 Pontina Km 52 snc, Campoverde di Aprilia, Latino 04011, Italy
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15
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Bassan A, Alves VM, Amberg A, Anger LT, Auerbach S, Beilke L, Bender A, Cronin MT, Cross KP, Hsieh JH, Greene N, Kemper R, Kim MT, Mumtaz M, Noeske T, Pavan M, Pletz J, Russo DP, Sabnis Y, Schaefer M, Szabo DT, Valentin JP, Wichard J, Williams D, Woolley D, Zwickl C, Myatt GJ. In silico approaches in organ toxicity hazard assessment: current status and future needs in predicting liver toxicity. COMPUTATIONAL TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2021; 20:100187. [PMID: 35340402 PMCID: PMC8955833 DOI: 10.1016/j.comtox.2021.100187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Hepatotoxicity is one of the most frequently observed adverse effects resulting from exposure to a xenobiotic. For example, in pharmaceutical research and development it is one of the major reasons for drug withdrawals, clinical failures, and discontinuation of drug candidates. The development of faster and cheaper methods to assess hepatotoxicity that are both more sustainable and more informative is critically needed. The biological mechanisms and processes underpinning hepatotoxicity are summarized and experimental approaches to support the prediction of hepatotoxicity are described, including toxicokinetic considerations. The paper describes the increasingly important role of in silico approaches and highlights challenges to the adoption of these methods including the lack of a commonly agreed upon protocol for performing such an assessment and the need for in silico solutions that take dose into consideration. A proposed framework for the integration of in silico and experimental information is provided along with a case study describing how computational methods have been used to successfully respond to a regulatory question concerning non-genotoxic impurities in chemically synthesized pharmaceuticals.
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Affiliation(s)
- Arianna Bassan
- Innovatune srl, Via Giulio Zanon 130/D, 35129 Padova, Italy
| | - Vinicius M. Alves
- The National Institute of Environmental Health Sciences, Division of the National Toxicology, Program, Research Triangle Park, NC 27709, USA
| | - Alexander Amberg
- Sanofi, R&D Preclinical Safety Frankfurt, Industriepark Hoechst, D-65926 Frankfurt am Main, Germany
| | | | - Scott Auerbach
- The National Institute of Environmental Health Sciences, Division of the National Toxicology, Program, Research Triangle Park, NC 27709, USA
| | - Lisa Beilke
- Toxicology Solutions Inc., San Diego, CA, USA
| | - Andreas Bender
- AI and Data Analytics, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, UK
- Centre for Molecular Informatics, Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW
| | - Mark T.D. Cronin
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | | | - Jui-Hua Hsieh
- The National Institute of Environmental Health Sciences, Division of the National Toxicology, Program, Research Triangle Park, NC 27709, USA
| | - Nigel Greene
- Data Science and AI, DSM, IMED Biotech Unit, AstraZeneca, Boston, USA
| | - Raymond Kemper
- Nuvalent, One Broadway, 14th floor, Cambridge, MA, 02142, USA
| | - Marlene T. Kim
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, 20993, USA
| | - Moiz Mumtaz
- Office of the Associate Director for Science (OADS), Agency for Toxic Substances and Disease, Registry, US Department of Health and Human Services, Atlanta, GA, USA
| | - Tobias Noeske
- Imaging and Data Analytics, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gothenburg, Sweden
| | - Manuela Pavan
- Innovatune srl, Via Giulio Zanon 130/D, 35129 Padova, Italy
| | - Julia Pletz
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Daniel P. Russo
- Department of Chemistry, Rutgers University, Camden, NJ 08102, USA
- The Rutgers Center for Computational and Integrative Biology, Camden, NJ 08102, USA
| | - Yogesh Sabnis
- UCB Biopharma SRL, Chemin du Foriest – B-1420 Braine-l’Alleud, Belgium
| | - Markus Schaefer
- Sanofi, R&D Preclinical Safety Frankfurt, Industriepark Hoechst, D-65926 Frankfurt am Main, Germany
| | | | | | - Joerg Wichard
- Bayer AG, Genetic Toxicology, Müllerstr. 178, 13353 Berlin, Germany
| | - Dominic Williams
- Functional & Mechanistic Safety, Clinical Pharmacology & Safety Sciences, AstraZeneca, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, UK
| | - David Woolley
- ForthTox Limited, PO Box 13550, Linlithgow, EH49 7YU, UK
| | - Craig Zwickl
- Transendix LLC, 1407 Moores Manor, Indianapolis, IN 46229, USA
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16
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Drewe WC, Dobo KL, Sobol Z, Bercu JP, Parris P, Nicolette J. Deriving Compound-Specific Exposure Limits for Chemicals Used in Pharmaceutical Synthesis: Challenges in Expert Decision-Making Exemplified Through a Case Study-Based Workshop. Int J Toxicol 2021; 40:285-298. [PMID: 33525949 DOI: 10.1177/1091581820982547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A workshop entitled "Deriving Compound-Specific Exposure Limits for Chemicals Used in Pharmaceutical Synthesis" was held at the 2018 Genetic Toxicology Association annual meeting. The objectives of the workshop were to provide an educational forum and use case studies and live multiple-choice polling to establish the degree of similarity/diversity in approach/opinion of the industry experts and other delegates present for some of the more challenging decision points that need to be considered when developing a compound-specific exposure limit (ie, acceptable intake or permissible or permitted daily exposure). Herein we summarize the relevant background and case study information for each decision point topic presented as well as highlight significant polling responses and discussion points. A common observation throughout was the requirement for expert judgment to be applied at each of the decision points presented which often results in different reasoning being applied by the risk assessor when deriving a compound-specific exposure limit. This supports the value of precompetitive cross-industry collaborations to develop compound-specific limits and harmonize the methodology applied, thus reducing the associated uncertainty inherent in the application of isolated expert judgment in this context. An overview of relevant precompetitive cross-industry collaborations working to achieve this goal is described.
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Affiliation(s)
| | - Krista L Dobo
- 390190Pfizer Worldwide Research and Development, Groton, CT, USA
| | - Zhanna Sobol
- 390190Pfizer Worldwide Research and Development, Groton, CT, USA
| | | | - Patricia Parris
- Pfizer Worldwide Research and Development, Sandwich, Kent, UK
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17
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Sun X, Zheng X, Tang Y, Debrah AA, Du Z. Supercritical Fluid Extraction Combined with Ultrahigh Performance Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry for Determination of Extractables to Evaluate Compatibility of Drugs with Rubber Closures. AAPS PharmSciTech 2021; 22:50. [PMID: 33458791 DOI: 10.1208/s12249-020-01907-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/18/2020] [Indexed: 01/22/2023] Open
Abstract
Biological activity and pharmacological efficacy of protein drugs may be affected by the compatibility between drug and packaging materials. The compatibility of rubber closures seal cap has become the focus of many studies due to its complicated formulation. Despite of the significance of the issue, currently, there is little available data about organic leachables in drugs which is also not comprehensive. Since the concentration of migrants in drug is usually low and the matrix is complicated, the establishment of overall profile of extractables is crucial for the characterization of leachables. Herein, the supercritical fluid extraction (SFE) method was used because of its great extraction capacity and efficiency for low to medium polar extractables in rubber stoppers. The SFE conditions were optimized by response surface methodology (RSM). Experimental results of the extract yield were close to the predicted values (R2 = 0.95). Then the extractables were qualitatively and quantitatively analyzed with ultrahigh performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-QTOF MS). Finally, risk assessment was made by comparing predicted exposure with injection permitted daily exposure (pPDE) limit or threshold recommended by threshold of toxicological concern (TTC). The results showed that there are many extractables such as glyceride, fatty acids and derivatives, antioxidants, and degradation products. Among them degradation products were in the majority and content of 17 substances exceeded corresponding limits. Considering their unknown toxicology, more experiments are therefore needed to provide information on their toxicology and risk assessment. The study provides a reference for the compatibility of drugs, and quality supervision of pharmaceuticals packaging.
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18
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Parris P, Martin EA, Stanard B, Glowienke S, Dolan DG, Li K, Binazon O, Giddings A, Whelan G, Masuda-Herrera M, Bercu J, Broschard T, Bruen U, Callis CM, Stults CL, Erexson GL, Cruz MT, Nagao LM. Considerations when deriving compound-specific limits for extractables and leachables from pharmaceutical products: Four case studies. Regul Toxicol Pharmacol 2020; 118:104802. [DOI: 10.1016/j.yrtph.2020.104802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/24/2022]
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19
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Badding MA, Vargas JR, Fortney J, Cheng QJ, Ho CH. Toxicological risk assessment of bisphenol a released from dialyzers under simulated-use and exaggerated extraction conditions. Regul Toxicol Pharmacol 2020; 118:104787. [PMID: 33011233 DOI: 10.1016/j.yrtph.2020.104787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 01/16/2023]
Abstract
Bisphenol A (BPA) belongs to a group of chemicals used in the production of polycarbonate, polysulfone, and polyethersulfone which are used, among other applications, in the manufacture of dialyzers. While exposure to BPA is widespread in the general population, dialysis patients represent a population with potentially chronic parenteral BPA exposures. To assess the potential risk of BPA exposure to dialysis patients through dialyzer use, exposure estimates were calculated based on BPA levels measured by ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry following extractions from dialyzers manufactured by Fresenius Medical Care. Extraction conditions included both simulated-use leaching and exaggerated extractions to evaluate possible leachable and extractable BPA, respectively, from the devices. The mean BPA concentrations were 3.6 and 108.9 ppb from simulated-use and exaggerated extractions, respectively, from polycarbonate-containing dialyzers. No BPA was detected from polypropylene-containing dialyzers. Margins of Safety (MOS) were calculated to evaluate the level of risk to patients from estimated BPA exposure from the dialyzers, and the resulting MOS were 229 and 45 for simulated-use and exaggerated extractions, respectively. The findings suggest that there is an acceptable level of toxicological risk to dialysis patients exposed to BPA from use of the dialyzers tested in the current study.
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Affiliation(s)
| | - Jessica R Vargas
- Exponent, Inc, 149 Commonwealth Drive, Menlo Park, CA, 94025, USA
| | - Julian Fortney
- Exponent, Inc, 149 Commonwealth Drive, Menlo Park, CA, 94025, USA
| | - Qiuqiong J Cheng
- Fresenius Medical Care, Ltd, 475, West 13th Street, Ogden, UT, 84404, USA
| | - Chih-Hu Ho
- Fresenius Medical Care, Ltd, 475, West 13th Street, Ogden, UT, 84404, USA
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20
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Leachables from plastic materials in contact with drugs. State of the art and review of current analytical approaches. Int J Pharm 2020; 583:119332. [DOI: 10.1016/j.ijpharm.2020.119332] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 11/23/2022]
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21
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Recent Advances in Studying Interfacial Adsorption of Bioengineered Monoclonal Antibodies. Molecules 2020; 25:molecules25092047. [PMID: 32353995 PMCID: PMC7249052 DOI: 10.3390/molecules25092047] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/13/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Abstract
Monoclonal antibodies (mAbs) are an important class of biotherapeutics; as of 2020, dozens are commercialized medicines, over a hundred are in clinical trials, and many more are in preclinical developmental stages. Therapeutic mAbs are sequence modified from the wild type IgG isoforms to varying extents and can have different intrinsic structural stability. For chronic treatments in particular, high concentration (≥ 100 mg/mL) aqueous formulations are often preferred for at-home administration with a syringe-based device. MAbs, like any globular protein, are amphiphilic and readily adsorb to interfaces, potentially causing structural deformation and even unfolding. Desorption of structurally perturbed mAbs is often hypothesized to promote aggregation, potentially leading to the formation of subvisible particles and visible precipitates. Since mAbs are exposed to numerous interfaces during biomanufacturing, storage and administration, many studies have examined mAb adsorption to different interfaces under various mitigation strategies. This review examines recent published literature focusing on adsorption of bioengineered mAbs under well-defined solution and surface conditions. The focus of this review is on understanding adsorption features driven by distinct antibody domains and on recent advances in establishing model interfaces suitable for high resolution surface measurements. Our summary highlights the need to further understand the relationship between mAb interfacial adsorption and desorption, solution aggregation, and product instability during fill-finish, transport, storage and administration.
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22
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Sica VP, Krivos KL, Kiehl DE, Pulliam CJ, Henry ID, Baker TR. The role of mass spectrometry and related techniques in the analysis of extractable and leachable chemicals. MASS SPECTROMETRY REVIEWS 2020; 39:212-226. [PMID: 30921495 DOI: 10.1002/mas.21591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
In addition to degradation products, impurities, and exogenous contaminants, industries such as pharmaceutical, food, and others must concern themselves with leachables. These chemicals can derive from containers and closures or migrate from labels or secondary containers and packaging to make their way into products. Identification and quantification of extractables (potential leachables) and leachables, typically trace level analytes, is a regulatory expectation intended to ensure consumer safety and product fidelity. Mass spectrometry and related techniques have played a significant role in the analysis of extractables and leachables (E&L). This review provides an overview of how mass spectrometry is used for E&L studies, primarily in the context of the pharmaceutical industry. This review includes work flows, examples of how identification and quantification is done, and the importance of orthogonal data from several different detectors. E&L analyses are driven by the need for consumer safety. These studies are expected to expand in existing areas (e.g., food, textiles, toys, etc.) and into new, currently unregulated product areas. Thus, this topic is of interest to audiences beyond just the pharmaceutical and health care industries. Finally, the potential of universal detector approaches used in other areas is suggested as an opportunity to drive E&L research progress in this arguably understudied, under-published realm.
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Affiliation(s)
| | | | | | | | - Ian D Henry
- The Procter & Gamble Company, Mason, 45040, Ohio
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23
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Zhao L, Li P, Xu H, Han B, Chen J, Gao Z, Li J, Li X, Wu C. Toxicological safety evaluation in acute and 28-day studies of aqueous extract from Bei-Qi-Wu-Jia formula. JOURNAL OF ETHNOPHARMACOLOGY 2020; 248:112324. [PMID: 31644940 DOI: 10.1016/j.jep.2019.112324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Bei Qi Wu Jia (BQWJ), a modern preparation of a traditional Chinese medicinal formula, is a combination of Radix Astragali and Acanthopanacis Senticosi. Although BQWJ has been used to treat insomnia, fatigue, and loss of appetite, toxicological safety studies are rare in the literature. AIM OF THE STUDY To evaluate the acute and subacute toxicity of BQWJ extract after oral administration in mice and rats, respectively. MATERIALS AND METHODS In the acute toxicity study, mice underwent oral administration of 67.5 g extract/kg/day. In the subacute toxicity study, rats underwent a single oral administration of 1.25, 2.5, 5.0, or 10.0 g/kg/day of BQWJ extract for 28 days. The animals' general behavior, body weight, food intake, biochemical and hematologic parameters, organ coefficients, and pathological morphology were analyzed. RESULTS No evidence of toxicity was observed in the mice after acute exposure to BQWJ extract. The subacute results included no deaths and no changes in general behavior. Although BQWJ extract resulted in some significant changes in other parameters, these alterations cannot be considered treatment-related because they remained within normal ranges throughout the 28 days. CONCLUSIONS In conclusion, the oral administration of BQWJ extract at doses of less than 67.5 g/kg/day for 1 day or 10.0 g/kg/day for 28 consecutive days can be considered safe and showed no distinct toxicity or side effects in this study.
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Affiliation(s)
- Liutao Zhao
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Pan Li
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Hongde Xu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Bingqian Han
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Jingjing Chen
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Ziqing Gao
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Jianglong Li
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Xianbin Li
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
| | - Chunli Wu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, 450001, PR China; Key Laboratory of Technology of Drug Preparation (Zhengzhou University), Ministry of Education of China, Zhengzhou, 450001, PR China; Key Laboratory of Henan Province for Drug Quality and Evaluation, Zhengzhou, 450001, PR China.
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Gollapalli R, Singh G, Blinder A, Brittin J, Sengupta A, Mondal B, Patel M, Pati B, Lee J, Ghode A, Kote M. Identification of an Adduct Impurity of an Active Pharmaceutical Ingredient and a Leachable in an Ophthalmic Drug Product Using LC-QTOF. J Pharm Sci 2019; 108:3187-3193. [PMID: 31226425 DOI: 10.1016/j.xphs.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 11/25/2022]
Abstract
Impurity investigations are important in pharmaceutical development to ensure drug purity and safety for the patient. The impurities typically found in drug products are degradants or reaction products of the active pharmaceutical ingredient (API) or leachable compounds from the container closure system. However, secondary reactions may also occur between API degradants, excipient impurities, residual solvents, and leachables to form adduct impurities. We hereby report an adduct-forming interaction of API (moxifloxacin) with a leachable compound (ethylene glycol monoformate) in moxifloxacin ophthalmic solution. The leachable compound originated from a low-density polyethylene bottle used in the packaging of drug products. The adduct impurity was tentatively identified as 1-cyclopropyl-6-fluoro-7-(1-(2-(formyloxy)ethyl) octahydro-6H-pyrrolo[3,4-b]pyridin-6-yl)-8-methoxy-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (C24H28FN3O6, MW = 473.19621) using accurate mass LC-QTOF analysis. The mass accuracy error between the theoretical mass and the experimental mass of an impurity was found to be 0.2 ppm. An MS/MS analysis was utilized to provide mass spectrometry fragments to support verification of the proposed structure.
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Affiliation(s)
- Ramarao Gollapalli
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061.
| | - Gagandeep Singh
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - Alejandro Blinder
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - Jeremiah Brittin
- Mund-Lagowski Department of Chemistry and Biochemistry, Bradley University, Peoria, Illinois 61625
| | - Arijit Sengupta
- Mund-Lagowski Department of Chemistry and Biochemistry, Bradley University, Peoria, Illinois 61625
| | - Bikash Mondal
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - Milan Patel
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - Biswajit Pati
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - James Lee
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - Amit Ghode
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
| | - Mahesh Kote
- Research and Development, Akorn Pharmaceuticals, 50 Lakeview Parkway, Suite 112, Vernon Hills, Illinois 60061
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Dundon M, Madden O, Comizzoli P. Three-dimensional culture of endometrial cells from domestic cats: A new in vitro platform for assessing plastic toxicity. PLoS One 2019; 14:e0217365. [PMID: 31136609 PMCID: PMC6538153 DOI: 10.1371/journal.pone.0217365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022] Open
Abstract
Plastic polymers can be combined with additives that modify physical properties and stability of the material. However, the biocompatibility of those additives is not well known. The objective of the study was to characterize the impact of zinc stearate-a common additive-through the development of a novel three-dimensional (3-D) in vitro platform with endometrial cells from domestic cats. Epithelial and stromal cells from adult uteri were isolated and cultured in medium supplemented with 3% Matrigel for two weeks in plastic tissue culture dishes that had been identified as polystyrene with and without zinc stearate by Raman, FTIR, and X-ray fluorescence spectroscopies. Three-dimensional cell structures that were obtained were measured and categorized by shape. Cell viability, proliferation, differentiation, organization, and apoptosis then were assessed by immuno-staining. Results indicated that zinc stearate did not affect 3-D endometrial cell structure morphology, viability, or cellular composition. This first study of a new in vitro platform will be useful for studies testing the influence of other additives, drugs, or exogenous hormones.
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Affiliation(s)
- Morgan Dundon
- Center for Species Survival Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC, United States of America
- Smithsonian Museum Conservation Institute, Suitland, MD, Untied States of America
| | - Odile Madden
- Smithsonian Museum Conservation Institute, Suitland, MD, Untied States of America
| | - Pierre Comizzoli
- Center for Species Survival Smithsonian Conservation Biology Institute, National Zoological Park, Washington, DC, United States of America
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Scherer N, Marcseková K, Posset T, Winter G. New studies on leachables in commercial scale protein drug filling lines using stir bar sorptive extraction coupled with TD-GC–MS and UPLC/QTOF-MS/MS analytics. Int J Pharm 2019; 555:404-419. [DOI: 10.1016/j.ijpharm.2018.11.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/28/2022]
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Chong XM, Dong X, Yao SC, Hu CQ. Research on the relationship between cephalosporin structure, solution clarity, and rubber closure compatibility using volatile components profile of butyl rubber closures. Drug Dev Ind Pharm 2018; 45:159-167. [PMID: 30231654 DOI: 10.1080/03639045.2018.1526187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Establish an effective experimental strategy to determine the compatibility of rubber closures for drugs. SIGNIFICANCE Various types of rubber closures with different compositions are available for drug packaging. Many additives of rubber closures can be released from rubber closures and may affect the quality of drugs and pose a risk to human health. In this study, we aimed to determine the relationship between cephalosporin structure, solution clarity, and rubber closure compatibility using volatile components profile of butyl rubber closures. METHODS Two opposite polarity gas chromatography (GC) systems and GC-mass spectrometry (MS) were used to achieve rapid qualitative determination of the main volatile components in rubber closures. Simulated adsorption experiment was performed to investigate the adsorption of main volatile components in rubber closures by cephalosporins with different side chain structures, and to determine the effects of adsorption on solution clarity. RESULTS A volatile components screening library of rubber closures was established and the structures of some volatile component were confirmed. The specific adsorption of the structure of cephalosporins on volatile components from rubber closures was studied. CONCLUSION Based on the results of this study, rubber closures with good compatibility for cephalosporins with different side chain structures can be selected rapidly. This experimental strategy not only facilitates the screening of suitable rubber closures more effectively, but also enables the quick determination of volatile components adsorbed by drugs.
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Affiliation(s)
- Xiao-Meng Chong
- a National Institutes for Food and Drug Control , Beijing , China
| | - Xin Dong
- a National Institutes for Food and Drug Control , Beijing , China
| | - Shang-Chen Yao
- a National Institutes for Food and Drug Control , Beijing , China
| | - Chang-Qin Hu
- a National Institutes for Food and Drug Control , Beijing , China
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Woodward Z, Brooks P, Morris-Smith B, Wallis M, Ogbourne SM. Adsorption and Leachable Contamination of Flucloxacillin, Cyclosporin and Amiodarone Following Delivery Through an Intravenous Administration Set. Pharm Res 2018; 35:121. [PMID: 29675679 DOI: 10.1007/s11095-018-2409-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/13/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Interactions between a pharmaceutical drug and its delivery device can result in changes in drug concentration and leachable contamination. Flucloxacillin, amiodarone and cyclosporin were investigated for drug concentration changes and leachable contamination after delivery through an intravenous administration set. METHODS Flucloxacillin, amiodarone and cyclosporin were delivered through an intravenous administration set and the eluate analysed by HPLC-UV and HPLC-MS. RESULTS The average recovery of flucloxacillin was 99.7% and no leachable compounds were identified. The average recovery of cyclosporin was 96.1%, which contrasts previous findings that have reported up to 50% loss of cyclosporin. This is likely due to the use of DEHP-free administration sets in this study, as adsorption of cyclosporin is linearly related to DEHP content. The average recovery of amiodarone was 91.5%. 5-hydroxymethylfurfural was identified in the amiodarone solution following delivery through the administration set as well as the 5% glucose solution used for delivery. CONCLUSIONS Drug/administration set interactions may modify pharmaceuticals during delivery. In this study, only 90% of the amiodarone was delivered through a generic administration set. Given the growing use of generic administration sets in hospital settings, validation of the suitability of their use is required to ensure patient safety and expected levels of efficacy.
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Affiliation(s)
- Zachary Woodward
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
| | - Peter Brooks
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia
| | - Bernadette Morris-Smith
- Sunshine Coast Hospital Health Service, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Marianne Wallis
- Nursing and Midwifery Cluster for Research Excellence, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Steven M Ogbourne
- Genecology Research Centre, Faculty of Science, Health, Engineering and Education, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Queensland, 4558, Australia.
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Teasdale A, Elder DP. Analytical control strategies for mutagenic impurities: Current challenges and future opportunities? Trends Analyt Chem 2018. [DOI: 10.1016/j.trac.2017.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Toxicity assessment of the extractables from multi-layer coextrusion poly ethylene bags exposed to pH=5 solution containing 4% benzyl alcohol and 0.1 M sodium acetate. Regul Toxicol Pharmacol 2018; 94:47-56. [PMID: 29360483 DOI: 10.1016/j.yrtph.2018.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/20/2022]
Abstract
A non-target analysis was developed for the analysis of extractables from multi-layer coextrusion bags exposed to 4% benzyl alcohol solution and 0.1 M sodium acetate at pH = 5 for defined periods (15 day, 45 day and 90 day) according to manufacturer instructions based on the ultra-performance liquid chromatography (UPLC) quadrupole-time of flight mass spectrometry (Q-TOF MS). In order to confirm the extractables, principal component analysis (PCA) was used to indicate the differences among samples of different periods. Then, the extractables were identified based on searching the self-built library or online searching. The total content of extractables of 90 day samples was 589.78 μg/L, and the content was in the range of acceptable levels for pharmaceutical manufacturers. The risk assessment of the extractables were evaluated by Toxtree and T.E.S.T. software to avoid the animals bioexperiment.
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Wei Y, Wu Y, Zhu T, Li Z, Zhang Y. Identification of UV-absorbing extractables from rubber closures used in containers of injectable powder and safety assessment of leachables in the drug. J Pharm Biomed Anal 2017; 138:256-266. [DOI: 10.1016/j.jpba.2017.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/16/2022]
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