Stability of apomorphine hydrochloride in aqueous sodium bisulphite solutions

An evaluation of subcutaneous apomorphine for the treatment of Parkinson's disease

INTRODUCTION

Heterogeneity of symptoms and individual variability of progression characterizes Parkinson's disease. Unmet therapeutic needs include a cure, disease modification, and improvement of available marketed dopamine-substituting compounds. Personalized treatment, tailored to the patients' needs and symptoms, aims to ameliorate impaired motor behavior and non-motor features. Injection or infusion of apomorphine is a therapeutic option for more advanced patients with severe levodopa associated motor complications.

AREAS COVERED

This narrative review summarizes the subcutaneous administration, efficacy, and side effects of the non-ergot derivative dopamine agonist apomorphine following a non-systematic literature research.

EXPERT OPINION

Subcutaneous apomorphine hydrochloride application rapidly terminates intervals with severe motor impairment with bolus injections. Oscillation of motor behavior well responds to continuous apomorphine infusions. Long-term application of the commercially available apomorphine hydrochloride solution sooner or later affects skin and oral mucosa. Onset of skin nodules associated with subcutaneous tissue inflammation probably results from the antioxidant preservative sodium metabisulfite in the apomorphine solution. Addition of another better tolerated and safer antioxidant instead of sodium metabisulphite or use of an already available concentrated apomorphine-free base formulation will enhance its future use, its tolerability, safety, and acceptance of subcutaneous and sublingual application.

Challenges and trends in apomorphine drug delivery systems for the treatment of Parkinson's disease

Parkinson's disease (PD) is a chronic debilitating disease affecting approximately 1% of the population over the age of 60. The severity of PD is correlated to the degree of dopaminergic neuronal loss. Apomorphine has a similar chemical structure as the neurotransmitter dopamine and has been used for the treatment of advanced PD patients. In PD patients, apomorphine is normally administered subcutaneously with frequent injections because of the compound's extensive hepatic first-pass metabolism. There is, hence, a large unmet need for alternative administrative routes for apomorphine to improve patient compliance. The present review focuses on the research and development of alternative delivery of apomorphine, aiming to highlight the potential of non-invasive apomorphine therapy in PD, such as sublingual delivery and transdermal delivery.

Stability of apomorphine in solutions containing selected antioxidant agents

Apomorphine in solution undergoes rapid autoxidation, producing greenish colored solutions, making it difficult to formulate as a stable pharmaceutical solution. To identify the optimum antioxidant agent/combination for apomorphine solution, a high performance liquid chromatography assay was used to study the stability of 50 μg/mL apomorphine HCI in 0.1% L-ascorbic acid (AA), 0.1% sodium metabisulfite (SMB), 0.1% EDTA, and in selected combinations at 25°C, 32°C, and 37°C over a period of 14 days. The stability of apomorphine HCl (10 mg/mL) in 0.1% AA solution and in 0.1% EDTA solution at 25°C and 37°C was also evaluated. Apomorphine HCI solution (50 μg/mL) in 0.1% AA plus 0.1% SMB solution retained 99.7% (at 25°C) and 95.9% (at 37°C) of the initial concentration, as 0.1% AA plus SMB solution minimized the reactive oxygen content in solution which, in turn, reduced the oxidation rate of apomorphine HCl, and there was no green coloration perceptible. Conversely, apomorphine HCl solution (50 μg/mL) in 0.1% SMB solution was unstable as only 0.53% (at 25°C) and 0.06% (at 37°C) of the initial concentration was retained after 14 days. All 10 mg/mL apomorphine HCl samples were stable in both studies. The initial concentration of apomorphine HCl solution markedly affected its rate of oxidation and discoloration. The addition of 0.1% AA to a current formulation of apomorphine HCl injection (Apomine^®), which contains SMB as an antioxidant, was recommended as providing the most stable solution.

Preactivated thiomers for intranasal delivery of apomorphine: In vitro and in vivo evaluation

The purpose of this study was to synthesize preactivated thiomers with different degrees of preactivation and to evaluate their potential as novel excipient for nasal apomorphine administration. The thiomer (PAA-cys) was synthesized by addition of thiol groups on poly(acrylic acid) with various molecular mass including 100, 250and450kDafollowed by immobilization of 2-mercaptonicotinic acid (2MNA) to thiol groups by disulfide bond formation resulting in PAA-cys-2MNA. These thiomers (PAA₁₀₀-cys, PAA₂₅₀-cys and PAA₄₅₀-cys) were in the next step preactivated by 56.3, 59.5 and 46.5% (medium degree), and 80.1, 81.6 and 87% (high degree), respectively. Apomorphine permeation across porcine nasal mucosa in the presence of PAA₁₀₀-cys-2MNA, PAA₂₅₀-cys-2MNA and PAA₄₅₀-cys-2MNA with high degree of preactivation was 3.1-, 4.4- and 4.1-fold, while 2.7-, 3.4- and 3.0-fold higher than control for medium degree of preactivation, respectively. Administration of apomorphine in the presence of PAA₂₅₀-cys-2MNA showed in rats 9 and ∼2-fold improvement of relative bioavailability compared with oral and intranasal administration of apomorphine solution, respectively. Because of the pronounced improvement among other polymers, PAA₂₅₀-cys-2MNA with high degree of preactivation could be considered as promising excipient for nasal delivery of apomorphine.

Making methods rugged for regulated bioanalysis

Methods started in discovery are optimized as they progress through preclinical and clinical development. Making a robust assay includes testing individual steps for consistency and points of failure. Assays may be transferred, optimized and revalidated several times. A rugged assay will not only meet regulatory requirements, but will execute with a low failure rate and confirm results under repeat analysis. Challenging aspects such as differential recovery, sample stabilization, resolution of isomers or conjugate analysis must be tackled and made routine. The proper selection of the IS can overcome limitations. It is best to know the potential points of failure before a study has started, but lessons learned from each study also provide invaluable insights to improve assay ruggedness.

Metallothionein I,II deficient mice do not exhibit significantly worse long-term behavioral outcomes following neonatal hypoxia-ischemia: MT-I,II deficient mice have inherent behavioral impairments

Metallothionein I and II are small metal binding proteins with a high affinity for zinc. They are found in the CNS and are thought to play a role in modulating the effects of free zinc. We hypothesized that MT-I,II deficient mice would have more neurological deficits both functionally and anatomically following a neonatal hypoxic-ischemic (HI) insult than wild-type mice subjected to the same insult. Forty wild-type and 40 MT-I,II deficient C57 X 129T2 F1 P10 mice were randomized to either 45 min of HI or sham HI. Beginning on P50, the mice were given a series of behavioral tests including locomotor activity, novel object recognition, Morris water maze (cued, hidden platform, reduced platform), a 2-week-delayed probe trial and an apomorphine-induced rotation test. At the conclusion of testing, the brains were removed for histological analysis including staining with NeuN and GFAP to assess neuronal loss and reactive gliosis. There were no significant differences in functional or anatomic measures between the wild-type HI mice and the MT-I,II deficient HI mice. The MT-I,II deficient mice exhibited an impaired rate of learning in the spatially oriented mazes but once learned retained the information as well as the wild-type mice. The absence of functional MT-I,II proteins does not result in significantly worse injury following 45 min of HI on P10. The MT-I,II deficient mice have baseline impairments in spatial learning but not retention.

Isoflurane-delayed preconditioning reduces immediate mortality and improves striatal function in adult mice after neonatal hypoxia-ischemia

BACKGROUND

Exposure to hypoxia and isoflurane (Iso) before hypoxia-ischemia has been found to be neuroprotective in neonatal rats. We investigated the long-term effects of delayed preconditioning with Iso, hypoxia, or room air on motor and cognitive function in mice that had 65 min of hypoxia-ischemia on postnatal day 10.

METHODS

Nine-day-old C57x129T2 F1 mice received either 1.8% Iso, hypoxic (10% O2 in N2), or sham (room air) preconditioning. The following day, the mice were subjected to permanent right common carotid ligation or sham ligation followed by 65 min of hypoxia, or room air. At 70 days of age, learning was tested using a series of Morris water maze tests. Striatal function was assessed by response to apomorphine injection. Histological analysis was performed on adult brain (P120) sections of striatum and dorsal hippocampus.

RESULTS

Iso preconditioning 24 h before severe neonatal hypoxia-ischemia reduced preweaning mortality from 20% to 0% (P < 0.04) and improved striatal function in adult mice, as assessed by circling after apomorphine injection (P < 0.028), but no improvements in performance were noted in the spatial-reference memory water maze tests. Hypoxic preconditioning improved learning relative to the sham-preconditioned group on the hidden maze, but not the more difficult reduced maze test of spatial memory. It had no significant effect on preweaning mortality and apomorphine response. Histologic analysis showed the hippocampus of non-preconditioned and Iso-preconditioned animals to be equally injured.

CONCLUSION

Iso and hypoxia confer selective functional neuroprotection in a delayed preconditioning paradigm in neonatal mice.

Adult neurological function following neonatal hypoxia-ischemia in a mouse model of the term neonate: water maze performance is dependent on separable cognitive and motor components

BACKGROUND AND PURPOSE

Hypoxic-ischemic injury in term neonates remains a significant cause of long-term neurological morbidity. The post-natal day 10 (P10) mouse is accepted as a model for the term human. This study was designed to assess the relationships between the duration of hypoxia-ischemia (HI) on P10 and the structural and functional neurological deficits that appear in the adult mouse as a consequence.

METHODS

Post-natal day 10 129T2xC57Bl/6 F1 hybrid mice were subjected to 0, 45, 60 or 75 min of hypoxia-ischemia using the Rice-Vannucci model. Beginning on P50 these mice were tested over the next 8 weeks using zero maze, locomotor activity, novel object recognition, cued, hidden and reduced Morris water mazes, delayed probe trials and response to apomorphine injection. Brain weights and histology were obtained at the end of testing.

RESULTS

The degree of structural and behavioral abnormalities in adult mice correlated with the duration of hypoxia-ischemia on P10. Useful behavioral tests for separating adult mice according to duration of hypoxia-ischemia on P10 include locomotor activity, the Morris water mazes and response to apomorphine. We found cued "learning" persisted, although latencies increased, with increasing HI time while spatial learning decayed as a function of HI time. Severe HI injury involving the ventral hippocampus resulted in excessive locomotor activity.

CONCLUSIONS

After correcting for motor deficits, there is evidence for persistence of "cued" learning but not spatial learning with increasing hypoxia-ischemia time on P10 in this model system.

Determination of apomorphine in canine plasma by liquid chromatography–electrospray ionization mass spectrometry and its application to a pharmacokinetic study

An LC-ESI-MS method was developed and validated for the assay of apomorphine in canine plasma using one-step liquid-liquid extraction. The analytes were separated on a Phenomenex Gemini C18 (150 mm x 2.0 mm id 3 microm) column and determined by MS in the positive ion mode. The linear range was 0.4-40 ng/mL with an LOD of 0.2 ng/mL for apomorphine in plasma. The intraday and interday precision and accuracy of quality control samples were < 5.9% RSD and < 7.5% bias for apomorphine. Extraction recoveries were > 80%. The validated method was successfully applied to analyze canine plasma samples in a pharmacokinetic study of apomorphine in dogs and detailed pharmacokinetic parameters were calculated.

Chiral capillary electrophoretic method for quantification of apomorphine

A new method for chiral determination of apomorphine enantiomers was developed and validated. Seven different neutral and charged cyclodextrins were tested for enantioselectivity on R,S-apomorphine. Sulfobutylether-beta-cyclodextrin was found to offer the best resolution, but with this system, four peaks were detected from a solution of the two enantiomers, which was suggested to be the result of different forms of the complex between the selector and apomorphine. A complexation constant was estimated for a complex of 1:1 ratio for the second and the fourth peak, whereas the other two peaks were fitted to a model ratio of 1:2 (analyte-selector). To avoid this phenomenon, hydroxypropyl-beta-cyclodextrin was then chosen as the chiral selector. An optimisation study was performed on three factors: concentration of the chiral selector, pH of the buffer, and applied voltage. Optimum conditions were: 14 mM of hydroxypropyl-beta-cyclodextrin, pH 3.0, and 16 kV. UV detection was at 200 nm. The method was validated at the chosen conditions, offering a limit of detection of 0.2 microM and a limit of quantification of 0.5 microM. The validated method was applied for the determination of R,S-apomorphine in a transport study with an in vitro cell culture model of the intestinal mucosa (Caco-2).