Mathematical equations to calculate true mycophenolic acid concentration in human plasma by using two immunoassays with different cross-reactivities with acyl glucuronide metabolite: comparison of calculated values with values obtained by using an HPLC-UV method

BACKGROUND

Both immunoassays and chromatographic methods are available for therapeutic drug monitoring of mycophenolic acid (MPA). Although chromatographic methods are more precise, immunoassays are widely used in clinical laboratories due to ease of adopting such assays on automated analyzers. We studied the possibility of using mathematical equations to calculate true MPA concentration by accounting for acyl glucuronide cross-reactivities with immunoassays by using two immunoassays with widely different cross-reactivities with the metabolite.

METHODS

We determined MPA concentrations in 20 specimens obtained from transplant recipients using cloned enzyme donor immunoassay (CEDIA) assay and a new particle enhanced turbidimetric inhibition immunoassay (PETINIA) assay. Then we developed mathematical equations to calculate true MPA concentration using values obtained by both immunoassays and reported cross-reactivity of acyl glucuronide with respective immunoassays. Calculated concentrations were compared with values obtained by using a high-performance liquid chromatography combined with ultraviolet detection (HPLC-UV) method.

RESULTS

We obtained good correlation between calculated MPA concentrations and corresponding MPA level obtained by using HPLC-UV method. Using x-axis as the MPA concentrations determined by the HPLC-UV method and y-axis as the calculated MPA level, we observed the following regression equation: y = 1.083x - 0.0995 (r = 0.99, n = 20).

CONCLUSIONS

Mathematical equations can be used to calculate true MPA concentrations using two immunoassays with different cross-reactivities with acyl glucuronide metabolite.

Positive bias in mycophenolic acid concentrations determined by the CEDIA assay compared to HPLC-UV method: is CEDIA assay suitable for therapeutic drug monitoring of mycophenolic acid?

BACKGROUND

Both immunoassays and chromatographic methods are available for therapeutic drug monitoring of mycophenolic acid (MPA), an immunosuppressant. We studied the suitability of cloned enzyme donor immunoassay (CEDIA) assay for routine monitoring of MPA by comparing values obtained by the CEDIA assay with corresponding values obtained by using a high-performance liquid chromatography combined with ultraviolet detection (HPLC-UV) method.

METHODS

We compared MPA concentrations obtained by a reference HPLC-UV method and CEDIA assay on Hitachi 917 analyzer (Roche Diagnostics, Indianapolis, IN) using 60 patient specimens (18 liver transplant recipient and 42 kidney transplant recipients).

RESULTS

When MPA concentrations in all 60 transplant recipients obtained by the HPLC-UV (x-axis) method were compared with corresponding values obtained by the CEDIA method (y-axis), the following regression equation was obtained: y = 1.1558x + 0.2876 (r = 0.97). Interestingly, much lower bias was observed in 42 renal transplant recipients as revealed by the following regression equation; y = 1.1181x + 0.2745 (r = 0.98). However, more significant positive bias was observed in 18 liver transplant recipients as following regression equation as observed: y = 1.3337x + 0.1493 (r = 0.94).

CONCLUSIONS

We conclude that MPA concentrations determined by the CEDIA assay showed significant positive bias compared to HPLC-UV method. Therefore, caution must be exercised in interpreting therapeutic drug monitoring result of MPA if CEDIA assay is used.

Effect of mycophenolate acyl-glucuronide on human recombinant type 2 inosine monophosphate dehydrogenase

BACKGROUND

The immunosuppressive effect of mycophenolic acid (MPA) is essentially attributed to IMPDH II inhibition, which leads to a reduction of lymphocyte proliferation. We investigated the action of the MPA metabolites MPA-phenyl-glucuronide (MPAG) and MPA-acyl-glucuronide (AcMPAG) on recombinant human IMPDH II (rhIMPDH II), as well as their passage into lymphocytes in vitro.

METHODS

We measured rhIMPDH II activity spectrophotometrically through the initial velocity of NADH formation, leading to the computation of the kinetic parameters K(m), IC(50), and K(i) (Michaelis constant, half-maximal inhibition concentration, and inhibition constant). We measured intracellular and extracellular concentrations of MPA, MPAG, and AcMPAG after incubation of Jurkat lymphoma cells with each compound separately, using liquid chromatography-tandem mass spectrometry.

RESULTS

MPA and AcMPAG showed an inhibition of rhIMPDH II (IC(50) 25.6 microg/L and 301.7 microg/L, respectively; the K(i) of MPA for NAD and IMP was 50.8 and 57.7 nmol/L, respectively; and that of AcMPAG for NAD and IMP was 382.0 and 511.0 nmol/L. MPAG had no significant effect on the enzyme. AcMPAG apparently acts by the same uncompetitive inhibition mechanism as MPA, with a 12-fold higher IC(50) and an 8-10 times higher K(i). When coincubated with MPA, AcMPAG activity was negligible at pharmacological concentrations. Furthermore, after 6-h incubation at their respective maximum concentration (C(max)), MPA was 10 times more concentrated in Jurkat cells than AcMPAG.

CONCLUSIONS

AcMPAG is a weaker inhibitor of rhIMPDH II than MPA and is less concentrated in lymphocytes in vitro, suggesting that it would not be pharmacologically active in vivo and might not need to be monitored in MPA-treated patients.

Simple reversed-phase liquid chromatographic assay for simultaneous quantification of free mycophenolic acid and its glucuronide metabolite in human plasma

A reversed-phase HPLC-UV method, involving simple instrumental setup and mobile phase without ion-pairing reagent, was developed and validated for direct simultaneous quantification of free mycophenolic acid (MPA) and its major metabolite MPA-glucuronide (MPAG) in human plasma. Both free MPA and MPAG were isolated from plasma samples using ultrafiltration prior to analysis. Each chromatographic run was completed within 13 min. The optimized method showed good performance in terms of specificity, linearity (r(2)=0.9999), sensitivity (limit of quantitation (LOQ): 0.005 mg/L for MPA; 1 mg/L for MPAG), and intra- and inter-day precision (R.S.D.<7%). This assay was successfully applied to free MPA and MPAG measurements in clinical samples.

Trace mycotoxin analysis in complex biological and food matrices by liquid chromatography–atmospheric pressure ionisation mass spectrometry

Mycotoxins are toxic secondary metabolites produced by filamentous fungi that are growing on agricultural commodities. Their frequent presence in food and their severe toxic, carcinogenic and estrogenic properties have been recognised as potential threat to human health. A reliable risk assessment of mycotoxin contamination for humans and animals relies basically on their unambiguous identification and accurate quantification in food and feedstuff. While most screening methods for mycotoxins are based on immunoassays, unambiguous analyte confirmation can be easily achieved with mass spectrometric methods, like gas chromatography/mass spectrometry (GC/MS) or liquid chromatography/mass spectrometry (LC/MS). Due to the introduction of atmospheric pressure ionisation (API) techniques in the late 80s, LC/MS has become a routine technique also in food analysis, overcoming the traditional drawbacks of GC/MS regarding volatility and thermal stability. During the last few years, this technical and instrumental progress had also an increasing impact on the expanding field of mycotoxin analysis. The aim of the present review is to give an overview on the application of LC-(API)MS in the analysis of frequently occurring and highly toxic mycotoxins, such as trichothecenes, ochratoxins, zearalenone, fumonisins, aflatoxins, enniatins, moniliformin and several other mycotoxins. This includes also the investigation of some of their metabolites and degradation products. Suitable sample pre-treatment procedures, their applicability for high sample through-put and their influence on matrix effects will be discussed. The review covers literature published until July 2006.

Validation of a Rapid and Sensitive Liquid Chromatography–Tandem Mass Spectrometry Method for Free and Total Mycophenolic Acid

Background: Because mycophenolic acid (MPA) is highly protein bound and because the free fraction is the pharmacologically active portion, a rapid, reliable, and sensitive procedure is required to study the relationship between free MPA and treatment efficacy/toxicity. Liquid chromatography–tandem mass spectrometry is ideally suited for such a method.

Methods: Free MPA was isolated from plasma by ultrafiltration. An online extraction cartridge with a column-switching technique, analytical liquid chromatography over an Aqua Perfect C18 column, and electrospray tandem mass spectrometry was used to quantify free and total MPA. To investigate ion suppression, a continuous infusion of MPA was introduced into the effluent from the HPLC column, and different ultrafiltrates and extracted plasma samples were injected on the column.

Results: A chromatographic run time of 4 min separated MPA from metabolites and internal standard, thereby avoiding interference from in-source fragmentation. Ion suppression occurred well before elution of MPA and internal standard. The lower limit of quantification for free MPA was 0.5 μg/L, and the method was linear to 1000 μg/L. Interassay imprecision (CV) was &lt;10% for free MPA (0.5–333 μg/L). Agreement was good for free MPA (n = 52) and total MPA (n = 106) between the proposed method and a validated HPLC method with ultraviolet detection. The Passing–Bablok regression line was: y = 0.95x + 0.27 μg/L for free MPA and y = 0.98x + 0.03 mg/L for total MPA.

Conclusions: The presented method allows the accurate, precise, and rapid determination of free and total MPA in plasma over a wide analytical range covering the concentrations relevant to pharmacokinetic studies and routine monitoring of this drug.

Limited Sampling Strategy for the Estimation of Mycophenolic Acid Area under the Curve in Adult Renal Transplant Patients Treated with Concomitant Tacrolimus

Background: Significant relationships between the mycophenolic acid (MPA) area under the concentration–time curve (AUC0–12h) and the risks for acute rejection and side effects have been reported. We developed a practical method for estimation of MPA AUCs. Regression equations were developed using repeated cross-validation for randomly chosen subsets, characterized statistically, and verified for acceptable performance.

Methods: Twenty-one renal transplant patients receiving 0.5 or 1.0 g of mycophenolate mofetil twice daily and concomitant tacrolimus provided a total of 50 pharmacokinetic profiles. MPA concentrations were measured by a validated HPLC method in 12 plasma samples collected at predose and at 30 and 60 min; 2, 3, 4, 6, 8, 9, 10, 11, and 12 h; 1 and 2 weeks; and 3 months after transplantation. Twenty-six 1-, 2-, or 3-sample estimation models were fit (r2 = 0.341–0.862) to a randomly selected subset of the profiles using linear regression and were used to estimate AUC0–12h for the profiles not included in the regression fit, comparing those estimates with the corresponding AUC0–12h values, calculated with the linear trapezoidal rule, including all 12 timed MPA concentrations. The 3-sample models were constrained to include no samples past 2 h.

Results: The model using c0h, c0.5h, and c2h was superior to all other models tested (r2 = 0.862), minimizing prediction error for the AUC0–12h values not included in the fit (i.e., the cross-validation error). The regression equation for AUC estimation that gave the best performance for this model was: 7.75 + 6.49c0h + 0.76c0.5h + 2.43c2h. When we applied this model to the full data set, 41 of the 50 (82%) estimated AUC values were within 15% of the value of AUC0–12h calculated using all 12 concentrations.

Conclusions: This limited sampling strategy provides an effective approach for estimation of the full MPA AUC0–12h in renal transplant patients receiving concomitant tacrolimus therapy.

Potential lack of specificity using electrospray tandem-mass spectrometry for the analysis of mycophenolic acid in serum

The remarkably strong formation of the mycophenolic acid molecular ion from mycophenolic acid glucuronide during electrospray atmospheric pressure ionization in patients' serum samples is described. It is concluded that because of this effect appropriate chromatographic separation prior to tandem-mass spectrometric analysis and correct peak detection and integration of the respective multiple reaction monitoring traces is mandatory probably in all cases where conjugate drug metabolites are present in post-dose samples.

Therapeutic drug monitoring for immunosuppressants

BACKGROUND

Immunosuppressants have significantly increased patient survival, e.g. in renal transplant up to 90% for the first year.

METHODS

Four immunosuppressants are used for clinical applications in the United States: cyclosporine (CsA) (Sandimmune and Neoral), FK 506-tacrolimus (ProGraf), mycophenolic mofetil (CellCept)--the prodrug for the mycophenolic acid (MPA), and rapamycin (RAPA) (Sirolimus). For CsA and FK 506, the rationale for monitoring is due to the variable pharmacokinetics, acute infection, dosage adjustment, non-compliance check, and for long-term maintenance therapy. Targeted whole blood concentrations ranges are: for CsA, 100-400 ng/ml depending on the methods, therapy and organs; and for FK 506, 5-20 ng/ml. For MPA, drug bioavailability--the plasma area-under-curve up to 12 h of 32.2-60.6 mg h/l was correlated to the biopsy-proven rejection rate of <10%. Monitoring is advocated for liver and renal transplants, for pediatrics, and for checking for non-compliance. RAPA monitoring is useful to check for variable pharmacokinetics, for non-compliance and others. The therapeutic range is tentatively targeted for 5-15 ng/ml. Monitoring methodologies are: for CsA, immunoassays such as fluorescence polarization immunoassay, and liquid chromatography (LC); for FK 506, microparticle enzyme immunoassay (MEIA); for MPA, enzyme multiplied immunoassay and LC; and for RAPA, MEIA, LC and LC-mass spectrometry. Proficiency survey programs for CsA and FK 506 are available from the US and Europe.

CONCLUSIONS

Monitoring of immunosuppressants has become an essential adjunct to the drug therapy for organ transplant patients.

Quantification of mycophenolate mofetil in human skin extracts using high-performance liquid chromatography-electrospray mass spectrometry

A sensitive and selective method for the quantification of mycophenolate mofetil and its active metabolite mycophenolic acid in different human skin layers after dermal administration is presented. The skin layers were separated after in vitro penetration experiments and a methanolic extraction was performed. Positive ion electrospray HPLC-MS in selected ion monitoring mode was used to quantify the substances after isocratic separation by a C18 analytical column. The minimum detectable concentrations were 850 pg/ml for MMF and 1 ng/ml for MPA. The peak areas depended linearly on the concentration of both drugs over the range of 25-1,000 ng/ml (r2 > or = 0.996) with accuracy < or =9.8% and precision < or = 13.2%. Total imprecision at quantification limits was 15.2% at 10 ng/ml and 16.3% at 1,500 ng/ml for MMF and 15.1% at 21.0 ng/ml and 17.5% at 1,300 ng/ml for MPA. This HPLC-MS method will be applicable to the profiling of MMF amounts in skin and its conversion to MPA after application of different formulations.