Semi-automated high-performance liquid chromatographic determination of cyclosporine A in whole blood using one-step sample purification and column-switching

Simultaneous quantitative determination of cyclosporine A and its three main metabolites (AM1, AM4N and AM9) in human blood by liquid chromatography/mass spectrometry using a rapid sample processing method

We have developed a sensitive and specific liquid chromatography/mass spectrometry (LC/MS) method for the simultaneous determination of cyclosporine A (CsA) and its three main metabolites (AM1, AM4N and AM9) in human blood. Following protein precipitation, supernatant was directly injected into the LC/MS system. Chromatographic separation was accomplished on a Symmetry C8 (4.6 x 75 mm, 3.5 microm) column with a linear gradient elution prior to detection by atmospheric pressure chemical ionization (APCI) MS using selected ion monitoring (SIM) in positive mode. This method can be applied to single mass equipment. The analytical range for each analyte was set at 1-2500 ng/mL using 100 microL of blood sample. The analytical method was fully validated according to FDA guidance. Intra-day mean accuracy and precision were 95.2-113.5% and 0.9-8.9%, respectively. Inter-day mean accuracy and precision were 95.8-107.0% and 1.5-10.7%, respectively. In blood all analytes were stable during three freeze/thaw cycles, for 24 h at room temperature and for 12 months at or below -15 degrees C. Stability was also confirmed in processed samples for 24 h at 10 degrees C and for 6 months at 4 degrees C in methanol. In addition, we confirmed the method could avoid matrix effects from transplant subjects' samples. This LC/MS technique provided an excellent method for simultaneous quantitative determination of CsA and its three metabolites for evaluation of their pharmacokinetic profiles.

Development of a HPLC method for the determination of cyclosporin-A in rat blood and plasma using naproxen as an internal standard

An isocratic reversed phase high-performance liquid chromatographic (HPLC) method with ultraviolet detection at 205 nm has been developed for the determination of cyclosporin-A (CyA) in rat blood and plasma. Naproxen was successfully used as an internal standard. Blood or plasma samples were pretreated by liquid-liquid extraction with diethyl ether. The ether extract was evaporated and the residue was reconstituted in acetonitrile-0.04 M monobasic potassium phosphate buffer (pH 2.5) solvent mixture. After washing with n-hexane, 30 microl of the reconstituted solution was injected into HPLC system. Good chromatographic separation between CyA and internal standard peaks was achieved by using a stainless steel analytical column packed with 4 microm Nova-Pak Phenyl material. The system was operated at 75 degrees C using a mobile phase consisting of acetonitrile-0.04 M monobasic potassium phosphate (pH 2.5) (65:35 v/v) at a flow rate of 1 ml/min. The calibration curve for CyA in rat blood was linear over the tested concentration range of 0.0033-0.0166 M with a correlation coefficient of 0.989. For rat plasma, the range of the concentrations tested were between 0.002 and 0.0166 M and showed linearity with a correlation coefficient of 0.953. The intra- and inter-run precision and accuracy results were 1.24-21.87 and 3.1-12.23%, respectively. The low volume of blood or plasma needed (200 microl), simplicity of the extraction process, short run time (5 min) and low injection volume (30 microl) make this method suitable for quick and routine analysis.

Rapid, sensitive high-performance liquid chromatographic method for the determination of cyclosporin A and its metabolites M1, M17 and M21

Cyclosporin A (CyA) and its metabolites seem to have nephro-, hepato- and neurotoxic side effects. Immunosuppressive therapy is a narrow path between the risk of rejection by underimmunosuppression and toxic organ damage by overdosage. Thus CyA dosage must be calculated to avoid the risks of organ rejection through underdosage and toxic organ damage through overdosage or accumulation of metabolites. In routine monitoring of CyA therapy, it can be important to measure not only the parent drug but also the metabolites. We describe a rapid and isocratic high-performance liquid chromatographic method for measurement of CyA and its metabolites M1, M17 and M21 in whole blood. CyA was detected by ultraviolet absorption at 212 nm with a CN analytical column maintained at 50 degrees C and recycling of hexane-isopropanol as mobile phase for improved long-term column stability and efficiency. The minimum detectable concentration of CyA and the three metabolites was 10 ng/ml blood. Our modified HPLC method for the determination of CyA and its metabolites is a simple (isocratic), rapid (the retention times were 7.1 min for CYD, internal standard, 8.9 min for CyA, 11.0 min for M21, 12.9 min for M17 and 16.3 min for M1) and economical method suitable for measuring the concentration of the major metabolite, M17, and for routine monitoring of CyA-treated patients.

Andrological status before and after liver transplantation

To determine the impact of liver transplantation on andrological status, we compared the endocrine profiles and spermiograms of 2 cohorts of patients before (9) and after (11) transplantation. Before liver transplantation testosterone (1.1 +/- 0.7 ng/ml) and free testosterone (2.0 +/- 1.6 pg/ml) were pathologically decreased in all 9 cases, and luteinizing hormone was lower (1.8 +/- 1.4 mIU/ml) in 5. Only 3 of 9 patients were able to produce ejaculates before liver transplantation, all of which were azoospermic. After a mean interval of 28 +/- 9 months (range 4 to 34 months) following liver transplantation testosterone (5.3 +/- 1.1 ng/ml), free testosterone (15.3 +/- 5.0 pg/ml) and luteinizing hormone (6.2 +/- 3.7 mIU/ml.) were consistently within the normal range, with a highly statistically significant difference (p < 0.025) from pre-liver transplantation values. Semen analyses after liver transplantation revealed normal density, motility and normal forms in 5 patients, 2 suffered from oligoasthenoteratospermia and 4 were unable to produce an ejaculate for semen analyses. These data demonstrate that the hypothalamic-pituitary-testicular hormone axis and gonadal tissue are capable of resuming normal function after liver transplantation in men with chronic liver failure who suffered from massive andrological dysfunction before transplantation.

Insensitivity to cyclosporine may explain the HLA-DRw6 recipient effect

Clinical as well as experimental studies have found an interindividual variability in the immunosuppressive effect of cyclosporine (CsA). In renal transplant patients treated with CsA and prednisolone alone, biopsy-verified rejections were significantly more frequent in DRw6-positive than in DRw6-negative graft recipients. The relative risk for developing a graft rejection independently of the CsA blood levels increased in HLA-DRw6-positive transplant patients. Although no statistical significance of the CsA levels within different DR phenotypes could be assessed, HLA-DR2-positive graft recipients with biopsy-verified rejection episodes had significantly lower CsA levels than DR2-negative patients (P = 0.01). Our results would indicate a very low CsA sensitivity of HLA-DRw6-positive graft recipients and might explain previous results describing an increased incidence of rejection and decreased graft survival rates in these patients.

Monitoring of the free concentration of cyclosporine in plasma in man

The free fraction of cyclosporine A (CsA) and its total plasma concentration as determined by HPLC(CsAT) were prospectively monitored in 66 recipients of renal transplants. The free CsA levels (CsAu) were calculated. The variability in free CsA levels was no less than for total CsAT levels. The correlation between CsAu and CsAT was high (r = 0.90). Both CsAT and CsAu covaried with serum triglycerides and apolipoprotein A1. Fourty-four of the 66 patients suffered acute rejection episodes on 69 occasions. CsAT and CSAu both decreased and to a similar extent at the occurrence of acute rejection (42% and 59% decrease, respectively; significant vs baseline. Not significant difference in decrease in CsAT vs CsAu). Acute nephrotoxicity occurred on 11 occasions in 10 patients. Both CsAT and CSAu were approximately twice as high at the time of acute nephrotoxicity as compared to one week previously. Both CsAT and CsAu were higher during the first month after transplantation in patients with than in patients without systemic infection. Thus, plasma CsAu gave no additional clinical information or guidance compared to CsAT in renal transplant recipients. Due to the complexity of its assay, which requires two consecutive analyses, there does not appear to be any need for routine monitoring of CsAu in renal transplant recipients.

Application of micellar mobile phases for the assay of drugs in biological fluids

Although micellar chromatography has been used for the determination of drugs in biological fluids since 1985, relatively few researchers have applied the technique to therapeutic monitoring. The reasons for this are rather unclear. It may be that most of the present extraction/reconstitution techniques are well established or that the method development procedure is unfamiliar. Significantly lower detection limits can be obtained with micellar mobile phases and column switching than with micellar mobile phases alone. Only two groups have used micellar mobile phases in conjunction with column switching for the determination of drugs in biological fluids. Since column switching with micellar mobile phases is a relatively new and untried technique, it will take some time before the full range of its applicability and limitations are known.

A prospective study of cyclosporine concentration in relation to its therapeutic effect and toxicity after renal transplantation

1. Cyclosporine (CsA) concentrations in plasma and whole blood were monitored prospectively in 66 consecutive kidney transplant recipients for 6 months after transplantation or until graft loss. Immunosuppression was based on treatment with CsA and prednisolone in 27 patients and CsA, azathioprine and prednisolone in 39 patients. 2. Whole blood and plasma samples (separated at 37 degrees C) were collected 10-12 h after CsA dosage twice weekly over the first 3 months and thereafter once weekly. CsA concentrations were measured by high pressure liquid chromatography (h.p.l.c.) in plasma, by specific and non-specific monoclonal radioimmunoassays (r.i.a.) in whole blood, and by polyclonal r.i.a. and polyclonal fluorescence polarization immunoassay (f.p.i.a.) in whole blood and plasma. 3. There were no differences between the treatment schedules regarding graft or patient survival, occurrence of acute rejection, nephrotoxicity or infection. 4. CsA concentrations were significantly lower at the time of acute rejection than one week earlier based on all of the analytical methods used except f.p.i.a. 5. The lowest CsA concentration, recorded during the first month after transplantation, was significantly lower in patients with than in patients without experience of acute rejection episodes when the CsA concentrations were measured by polyclonal r.i.a. in whole blood and plasma and by specific and non-specific monoclonal r.i.a. in whole blood, but not by h.p.l.c. in plasma or polyclonal f.p.i.a. in whole blood or plasma. 6. The highest CsA concentration recorded during the second post-transplantation month, was higher in patients with acute nephrotoxicity than in those without nephrotoxicity when CsA was measured by specific monoclonal r.i.a. in whole blood (471 +/- 409 ng ml-1 vs 327 +/- 150 ng ml-1, P less than 0.05), but not by the other methods. 7. The mean plasma h.p.l.c. concentration of CsA measured by h.p.l.c. during the first month after transplantation was significantly higher in patients who suffered from systemic infection than in patients who did not (116 +/- 70 ng ml-1 vs 82 +/- 52 ng ml-1; P less than 0.05). 8. Thus, significant relationships between CsA concentrations and clinical events were apparent using assay methods specific for CsA as well as using polyclonal r.i.a., but not using polyclonal f.p.i.a. When h.p.l.c. was used, however, plasma drug concentrations were often below the limit of determination. Our results suggest that specific analysis of CsA in whole blood allows the best distinction between patients who respond favourably and less favourably to treatment with CsA.

Chromatographic methods as tools in the field of mycotoxins

Achievements in the applications of chromatographic techniques in mycotoxicology are reviewed. Historically, column chromatography (CC) and paper chromatography (PC) were applied first, followed by thin-layer chromatography (TLC), high-performance liquid chromatography (HPLC) and gas chromatography (GC). Although PC techniques are no longer used in the analysis of mycotoxins, selected applications of PC are included to underline historical continuity. The most important achievements published from 1980 onwards are described. They include clean-up methods, TLC, CC, HPLC and GC of mycotoxins in environmental samples, foods, feeds, body fluids and in studies on biosynthesis and biotransformations of mycotoxins. Advantages and disadvantages of chromatographic techniques used in mycotoxicology are also evaluated.

Topical cyclosporine in high-risk corneal transplants

Cyclosporine (cyclosporin A, CsA) is a selective T-cell immunosuppressant that works primarily through inhibition of both antigen presentation and lymphokine production. It has dramatically improved the prognosis for solid organ transplantation. Significant nephrotoxicity has been associated with its systemic use. Topical CsA 2% was used in 11 high-risk corneal transplant patients (8 men; 3 women; average age, 44 years). Ten (91%) of 11 corneas remained clear at an average follow-up of 16 months (range, 6-24 months). All patients had transient epithelial keratitis. Systemic whole blood levels of CsA measured by high-performance liquid chromatography (HPLC) ranged from 14 to 64 ng/ml. All previous reports on the use of topical CsA in high-risk corneal transplant patients have not detected systemic CsA levels.

Determination of cyclosporin A in the serum of kidney transplant patients by rapid-flow fractionation and normal-phase high-performance liquid chromatography

High-performance liquid chromatography was used to determine cyclosporin A (CsA) concentrations in the serum of kidney transplant patients by rapid-flow fractionation (RFF) followed by silica gel normal-phase high-performance liquid chromatography (HPLC). The extraction of CsA from serum was achieved by RFF using a short diatomaceous earth column eluted with diethyl ether-n-hexane (50:50, v/v). The recovery was more than 80% at concentrations of 50-150 micrograms/l. The concentration of this compound was determined by HPLC using a conventional silica gel column with 3.3 M ammonia solution-ethanol-n-hexane (0.31:10.69:89, v/v) as eluent. Concentration calibration was made on the basis of the peak-height ratio of CsA to CsD as the internal standard. The coefficient of variation of this assay was less than 6.5% and the results were used for the therapeutic drug monitoring of CsA administered to kidney transplant patients. Measurements of the CsA concentrations in 160 serum specimens were also made by conventional radioimmunoassay (RIA) using commercial kits. The data obtained by RIA were on average 2.5 times those obtained by HPLC. Higher values in RIA were observed characteristically with patients with severe disfunction resulting from CsA hepatotoxicity. From the results, it appeared that HPLC rather than RIA provides more precise and reliable values for the concentration of this drug.

A simple improved method for the measurement of cyclosporin by liquid-liquid extraction of whole blood and isocratic HPLC

The current HPLC methods of cyclosporin measurement have been reviewed and all aspects assessed. A simple isocratic C-18 reverse phase HPLC method with improved efficiency is described for the routine measurement of cyclosporin in whole blood. An alkaline ether extraction is followed by an acid wash, solvent evaporation and two hexane washes of the reconstituted extract. The turn-round time for a single sample is 1 h. Daily batches of up to 40 patient samples can be easily measured with this method. The results are compared with those from the Sandoz radioimmunoassay (RIA) method.

Use of micellar mobile phases and microbore column switching for the assay of drugs in physiological fluids

The feasibility of directly assaying drugs in physiological fluids using on-line preconcentration and microbore high-performance liquid chromatography has been demonstrated. The untreated sample is injected onto a hydrophobic pre-column, using micellar sodium dodecyl sulfate (SDS) in the case of serum or phosphate buffer in the case of urine, as the load mobile phase. This traps the components of interest which are then backflushed onto a microbore analytical column using a stronger mobile phase. This procedure was then applied to diazepam in serum and phenobarbital in urine. Recovery was linear and quantitative over the range 30-3000 ng/ml for diazepam in serum and 2-200 micrograms/ml for phenobarbital in urine. The diazepam method was specific against caffeine and the three major metabolites of diazepam: oxazepam, temazepam, and nordiazepam. The effects of varying pre-column dimensions, pre-column loading time, and SDS concentration volume were evaluated.

Automated determination of drugs in serum by column-switching high-performance liquid chromatography. II. Separation of theophylline and its metabolites

The automated determination of theophylline and related compounds in human serum by column-switching high-performance liquid chromatography, including direct injection of serum samples, is described. TSK pre-column BSA-ODS and TSK gel ODS-80TM were used in the pre-column and analytical column, respectively. Serum samples of 20 microliters were directly injected on to the pre-column. After washing out serum proteins from the pre-column with 0.1 M NaH2PO4 at a flow-rate of 1.0 ml/min for 3.5 min, the effluent from the pre-column was introduced on to the analytical column by a column-switching device. The analysis was performed by stepwise gradient elution using 10 and 18% methanol in 0.1 M NaH2PO4. Theophylline and nine derivatives could be determined simultaneously within 40 min. The recovery of these compounds from serum was 95-103%. The linearity (1.0-50 micrograms/ml theophylline) and reproducibility (coefficient of variation less than 2.0%) were sufficient for drug monitoring at the lower and upper limits of therapeutic concentrations of theophylline.

High-performance liquid chromatographic column-switching method for two cyclosporine metabolites in blood

Cyclosporine (CSA) is biotransformed to many metabolites which may contribute to its immunosuppressive and nephrotoxic activity. We report a rapid and sensitive, automated column-switching high-performance liquid chromatographic (HPLC) method for measuring CSA-M17 in whole blood; the method also separates CSA-M1. CSA metabolite standards were isolated by a preparative-scale HPLC method. Samples were prepared by protein precipitation with acetonitrile followed by dilution with water. CSA-M17 was initially separated on a C8 column; final separation was on a C18 column. The inter-day relative standard deviation at 50 ng/ml was 8% (n = 3). Limit of detection was 20 ng/ml.

Intraindividual variability in the relative systemic availability of cyclosporin after oral dosing

We have measured total and unbound plasma concentrations of cyclosporin A in seven healthy men after single oral doses (12 mg per kg body weight) on two occasions at least two weeks apart. There was an up to two-fold intraindividual and a more than three-fold interindividual variation in the AUCs of both total and unbound drug. The intraindividual variability in the AUC of cyclosporin is similar to that of many other drugs and needs to be taken into account in the planning of pharmacokinetic studies.

Trace analysis of diazepam in serum using microbore high-performance liquid chromatography and on-line preconcentration

The feasibility of determining trace analytes in human serum using on-line preconcentration and microbore high-performance liquid chromatography has been demonstrated. The serum is subjected to ultracentrifugation and injected onto a hydrophobic pre-column using water as the mobile phase. This traps the components of interest which are then backflushed onto a microbore analytical column using a stronger mobile phase. The column-switching apparatus was evaluated using highly dilute aqueous paraben solutions and sample enrichment factors as high as 1500 were obtained. The procedure was then applied to diazepam in serum. Recovery was linear and quantitative over the range from at least 4 to 1000 ng/ml. The method was specific against caffeine and the three major metabolites of diazepam: oxazepam, temazepam, and nordiazepam. The effects of varying pre-column dimensions, pre-column loading time, and sample volume were evaluated.

New automated high-performance liquid chromatographic analysis of cyclosporin A and G in human serum

An automated isocratic high-performance liquid chromatographic (HPLC) method is described for the determination of cyclosporin A and G in human serum. This method involves the use of an automated solid-liquid extraction procedure following rapid protein precipitation with acetonitrile. The use of a disposable C8 extraction cartridge allows a good recovery of cyclosporine (87%) from serum and a detection limit of 20 ng/ml with good reproducibility using 0.5 ml of sample. This method can also be adapted to whole blood measurements. The choice of a 3-micron cyano analytical column and of the mobile phase hexane-isopropanol (85:15) permitted a low column temperature (50 degrees C), a low flow-rate (0.6 ml/min) and a short run time (14 min). This method allows the accurate and fast routine monitoring of cyclosporine by HPLC, which is particularly important in hepatic transplantations.

Measurement of cyclosporin A and of four metabolites in whole blood by high-performance liquid chromatography

A high-performance liquid chromatographic procedure using cyclosporin D as internal standard for the routine measurement of cyclosporin A and four of its metabolites is described. Whole-blood samples were purified on refillable solid-phase glass extraction columns. The chromatographic method includes a gradient elution using acetonitrile and water (pH 3.0) as eluents and an RP-8 analytical column. More than 1000 samples have already been analysed without any loss. The inter-assay variation was 6.3% and the intra-assay variation 4.9%. A linear correlation was found over a range of 0-3000 ng cyclosporin A per ml whole blood. The detection limit was 20 ng and the recovery was found to be 80-90%. Metabolites 1, 17, 18 and 21 could be characterized.

Determination of cyclosporin A in whole blood by high-performance liquid chromatography using automated column switching

A fully automated high-performance liquid chromatographic column-switching system is presented for the determination of cyclosporin A in whole blood. After blood proteins were precipitated with acetonitrile, the supernatant was automatically loaded on to a cyanopropyl column for initial separation, and then the fraction containing cyclosporin A was loaded on to a trimethylsilica column for final separation and quantitation. Cyclosporin A was detected by ultraviolet absorption at 205 nm. The minimum detectable concentration of cyclosporin A was 5 ng/ml in 100 microliter of blood. The coefficient of variation of the method was 1.755, 1.748 and 0.655% in whole blood when spiked at the 170, 425 and 850 ng/ml levels, respectively. One assay was completed in 15 min.