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Zhang YY, Guo HL, Wang J, Wang WJ, Li Y, Chu CC, Wu CY, Huang J, Hu YH, Chen F. LC-MS/MS and EMIT measure the whole blood concentration of cyclosporine A: The two methods yield concordant results within the dynamic range of the latter, but the former shows broader application scenarios. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1240:124154. [PMID: 38749100 DOI: 10.1016/j.jchromb.2024.124154] [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: 01/02/2024] [Revised: 04/27/2024] [Accepted: 05/07/2024] [Indexed: 06/03/2024]
Abstract
Cyclosporine A (CsA) is a widely used immunosuppressive drug with a narrow therapeutic index and large individual differences. Its therapeutic and toxic effects are closely related to blood drug concentrations, requiring routine therapeutic drug monitoring (TDM). The current main methods for TDM of CsA are enzyme multiplied immunoassay technique (EMIT) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). However, few study on the method comparison of the EMIT and LC-MS/MS for the measurement of whole blood CsA concentration in children has been reported. In this study, we developed a simple and sensitive LC-MS/MS assay for the determination of CsA, and 657 cases of CsA concentrations were determined from 197 pediatric patients by a routine EMIT assay and by the validated in-house LC-MS/MS method on the same batch of samples, aimed to address the aforementioned concern. Consistency between the two assays was evaluated using linear regression and Bland-Altman analysis. The linear range of LC-MS/MS was 0.500-2000 ng/mL and that of the EMIT was 40-500 ng/mL, respectively. Overall, the correlation between the two methods was significant (r-value ranging from 0.8842 to 0.9441). Unsatisfactory consistency was observed in the concentrations < 40 ng/mL (r = 0.7325) and 200-500 ng/mL (r = 0.6851). Bland-Altman plot showed a mean bias of -18.0 % (±1.96 SD, -73.8 to 37.8 %) between EMIT and LC-MS/MS. For Passing-Bablok regression between EMIT and LC-MS/MS did not differ significantly (p > 0.05). In conclusion, the two methods were closely correlated, but the CsA concentration by LC-MS/MS assay was slightly higher than that by EMIT method. Switching from the EMIT assay to the LC-MS/MS method was acceptable, and the LC-MS/MS method will receive broader application in clinical settings due to its better analytical capabilities, but the results need to be further verified in different laboratories.
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Affiliation(s)
- Yuan-Yuan Zhang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hong-Li Guo
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Jun Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yue Li
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Chen-Chao Chu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Chun-Ying Wu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jian Huang
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Feng Chen
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
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Yuan YS, Liao JM, Kang CM, Li BL, Lei XR, Yu KW, Chen L, Dong H, Ke PF, Xiao Y, Huang XZ, Zhao BB. A simple and accurate LC‑MS/MS method for monitoring cyclosporin A that is suitable for high throughput analysis. Exp Ther Med 2023; 26:342. [PMID: 37383376 PMCID: PMC10294601 DOI: 10.3892/etm.2023.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/14/2023] [Indexed: 06/30/2023] Open
Abstract
With time, the number of samples in clinical laboratories from therapeutic drug monitoring has increased. Existing analytical methods for blood cyclosporin A (CSA) monitoring, such as high-performance liquid chromatography (HPLC) and immunoassays, have limitations including cross-reactivity, time consumption, and the complicated procedures involved. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has long been considered the reference standard owing to its high accuracy, specificity, and sensitivity. However, large numbers of blood samples, multi-step preparation procedures, and longer analytical times (2.5-20 min) are required as a consequence of the different technical strategies, to ensure good analytical performance and routine quality assurance. A stable, reliable, and high throughput detection method will save personnel time and reduce laboratory costs. Therefore, a high throughput and simple LC-MS/MS method was developed and validated for the detection of whole-blood CSA with CSA-d12 as the internal standard in the present study. Whole blood samples were prepared through a modified one-step protein precipitation method. A C18 column (50x2.1 mm, 2.7 µm) with a mobile phase flow rate of 0.5 ml/min was used for chromatographic separation with a total running time of 4.3 min to avoid the matrix effect. To protect the mass spectrometer, only part of the sample after LC separation was allowed to enter the mass spectrum, using two HPLC systems coupled to one mass spectrometry. In this way, throughput was improved with detection of two samples possible within 4.3 min using a shorter analytical time for each sample of 2.15 min. This modified LC-MS/MS method showed excellent analytical performance and demonstrated less matrix effect and a wide linear range. The design of multi-LC systems coupled with one mass spectrometry may play a notable role in the improvement of daily detection throughput, speeding up LC-MS/MS, and allowing it to be an integral part of continuous diagnostics in the near future.
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Affiliation(s)
- Ying-Shi Yuan
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Jia-Min Liao
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Chun-Min Kang
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Bing-Ling Li
- Guangzhou KingMed Center for Clinical Laboratory Co., Ltd.; KingMed College of Laboratory Medical of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Xu-Ri Lei
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Ke-Wei Yu
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Lu Chen
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Heng Dong
- Guangzhou KingMed Center for Clinical Laboratory Co., Ltd.; KingMed College of Laboratory Medical of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Pei-Feng Ke
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Yao Xiao
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Xian-Zhang Huang
- Department of Laboratory Medicine, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
- Department of Laboratory Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Bei-Bei Zhao
- Guangzhou KingMed Center for Clinical Laboratory Co., Ltd.; KingMed College of Laboratory Medical of Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
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Watanabe T, Tanaka R, Ono H, Suzuki Y, Tatsuta R, Itoh H. Sensitive, wide-range and high-throughput quantification of cyclosporine in whole blood using ultra-performance liquid chromatography coupled to tandem mass spectrometry and comparison with an antibody-conjugated magnetic immunoassay. Biomed Chromatogr 2021; 35:e5128. [PMID: 33780006 DOI: 10.1002/bmc.5128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022]
Abstract
Because either trough or peak concentration at 2 h after administration is measured in routine therapeutic drug monitoring for cyclosporine A (CyA), a quantification method with a wide-range calibration curve capable of simultaneously measuring both concentrations is required. We developed a sensitive, wide-range and high-throughput quantification method for CyA in whole blood using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), and compared patients' blood CyA levels measured by UPLC-MS/MS and antibody-conjugated magnetic immunoassay (ACMIA). Whole blood samples were prepared by solid-phase extraction using Oasis HLB μElution plate. The UPLC-MS/MS assay showed excellent linearity over a wide calibration range of 5-2500 ng/mL. Within-batch accuracy and precision as well as batch-to-batch accuracy and precision fulfilled the criteria of US Food and Drug Administration guidelines. The blood CyA concentrations measured by the UPLC-MS/MS assay correlated strongly with those measured by ACMIA. A Bland-Altman plot showed a fixed error between CyA concentrations measured by the two methods, and the concentrations measured by the UPLC-MS/MS method were consistently lower than those measured by ACMIA. We have succeeded to develop a sensitive, wide-range and high-throughput quantification method for CyA in whole blood using UPLC-MS/MS.
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Affiliation(s)
- Takuma Watanabe
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan
| | - Hiroyuki Ono
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan
| | - Yosuke Suzuki
- Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Tokyo, Japan
| | - Ryosuke Tatsuta
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan
| | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital, Yufu, Oita, Japan
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Wang X, Qin W, Chen W, Liu H, Zhang D, Zhang X, Li P. Validation of a novel UPLC-HRMS method for human whole-blood cyclosporine and comparison with a CMIA immunoassay. Exp Ther Med 2021; 21:191. [PMID: 33488800 PMCID: PMC7812591 DOI: 10.3892/etm.2021.9623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/13/2020] [Indexed: 11/06/2022] Open
Abstract
Therapeutic drug monitoring is an essential tool when managing the therapeutic use of immunosuppressant cyclosporine A (CsA) in cases with solid organ transplantation. In China, the concentration of CsA is primarily measured using immunoassays. However, existing literature recommends mass spectrometry as the current gold standard for the quantitation of CsA. In the present study, it was attempted to develop a novel application to determine CsA concentrations by using ultra-performance liquid chromatography coupled to high-resolution mass spectrometry (UPLC-HRMS). This technique was then compared with a commercially available chemiluminescent microparticle immunoassay (CMIA) and it was investigated how clinical factors may contribute to quantitation differences between the two methods. An UPLC-Orbitrap-MS method was developed to determine CsA concentrations and this method was validated using guidelines put forward by the Food and Drug Administration from the US. In total, 127 blood samples were acquired from patients undergoing kidney transplantation and analyzed by UPLC-HRMS and CMIA assays. The novel method provided sensitive, accurate and precise results. The mean CsA concentration measured by CMIA was significantly higher than that measured by UPLC-HRMS (85.70±48.99 vs. 67.06±34.56 ng/ml, P<0.0001). Passing Bablok analysis yielded a slope of 1.34 (95% CI: 1.22-1.47) and an intercept of -2.54 (95% CI: -10.29-5.52). A group of samples with a higher metabolic ratio (hydroxylated CsA/CsA>1) exhibited larger discrepancies, while a group of samples taken from patients with a longer post-transplantation time (>10 years) featured narrow 95% CIs from -15.32 to 65.69%, as determined by Bland-Altman analysis. In summary, a reliable, accurate and rapid UPLC-HRMS method for CsA analysis was successfully developed. The measurement of CsA by the CMIA assay in renal transplant patients should be further evaluated with a specific focus on positive bias.
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Affiliation(s)
- Xiaoxue Wang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Wei Qin
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Wenqian Chen
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Huifang Liu
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Dan Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Xianglin Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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Wu L, Ye Z, Zhang X, Cheng Y, Zheng L, Qiu H, Liu X. Comparison of sample preparation methods, validation of an UPLC-MS/MS procedure for the quantification of cyclosporine A in whole blood sample. J Pharm Biomed Anal 2020; 193:113672. [PMID: 33129116 DOI: 10.1016/j.jpba.2020.113672] [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: 04/13/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
Current main methods for therapeutic drug monitoring (TDM) of cyclosporine A (CsA) are immunoassays and liquid chromatography tandem mass spectrometry. The sample pretreatment of these methods is mainly based on extraction of drug which is bound to erythrocytes by divalent heavy metal ions (such as zinc and copper). Although these methods are effective for whole blood drug extraction and measurement, the pollution of heavy metals in sample pretreatment process will have potential negative impact on environment and human health. To overcome the pollution problem, in this study we have developed and validated an UPLC-MS/MS method for CsA determination in whole blood samples using physical pretreatment method. According to the characteristics of erythrocytes, a series of physical pretreatment methods, including sonication, freeze-thaw and osmotic burst, have been developed and evaluated. The results showed that the osmotic burst method was an effective way for drug extraction from erythrocytes. The lower limit of quantitation for CsA was 25 ng/mL, the within-run and between-run coefficient of variations were both less than 11.6 %. The agreement of the UPLC-MS/MS methods using these two sample pretreatment was evaluated by Bland-Altman plot and the two-tailed Student's T-test. Comparison studies show that the effect of erythrocyte fragmentation by osmotic burst is similar to that of zinc sulfate method. The CsA measurement of 103 whole blood samples obtained by these two UPLC-MS/MS assays were no significant difference. These results demonstrate that the sample pretreatment by osmotic burst method is an eco-friendly and precise method for detecting the whole blood CsA concentration and therapeutic drug monitoring of CsA.
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Affiliation(s)
- Lingjie Wu
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China; Clinical Research Center for Phase I, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China; The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, China
| | - Zhenjie Ye
- Clinical Research Center for Phase I, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - Xiaoying Zhang
- Clinical Research Center for Phase I, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
| | - Yu Cheng
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Ling Zheng
- Clinical Research Center for Phase I, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China.
| | - Hongqiang Qiu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou 350001, China.
| | - Xiaolong Liu
- The United Innovation of Mengchao Hepatobiliary Technology Key Laboratory of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China; Clinical Research Center for Phase I, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China; The Liver Center of Fujian Province, Fujian Medical University, Fuzhou 350025, China.
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Wang X, gao Y, Yang Y, Liu Z, Gao L, Wu F, Yang X, Xu X, Wang Z, Sun S. Validation and evaluation of a newly developed time-resolved fluoroimmunoassay for cyclosporine quantitative analysis in human whole blood. J Pharm Biomed Anal 2020; 177:112890. [DOI: 10.1016/j.jpba.2019.112890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/20/2019] [Accepted: 09/20/2019] [Indexed: 12/24/2022]
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Mei S, Wang J, Chen D, Zhu L, Zhao M, Tian X, Hu X, Zhao Z. Simultaneous determination of cyclosporine and tacrolimus in human whole blood by ultra-high performance liquid chromatography tandem mass spectrometry and comparison with a chemiluminescence microparticle immunoassay. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1087-1088:36-42. [PMID: 29704799 DOI: 10.1016/j.jchromb.2018.04.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/28/2022]
Abstract
Overestimation of immunoassays for cyclosporine (CsA) and tacrolimus (TAC) analysis in human whole blood is a problem. The liquid chromatography tandem mass spectrometry is recommended as a golden method for CsA and TAC analysis. The aim of the study is to develop and validate an ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method for simultaneous determination of CsA and TAC in human whole blood and evaluate its agreement with a chemiluminescence microparticle immunoassay (CMIA). The UHPLC-MS/MS method for simultaneous determination of CsA and TAC in human whole blood was developed and validated according to the guidelines. A total of 177 CsA and 220 TAC samples were determined by UHPLC-MS/MS and CMIA, and the agreement of the two methods was evaluated by Bland-Altman plot. The calibration range of UHPLC-MS/MS method was 5 to 2000 ng/mL for CsA and 0.2 to 80 ng/mL for TAC. The inaccuracy and imprecision were -13.33% to 11.80% and <11.74% for CsA and -8.94% to 6.53% and <10.84% for TAC, respectively. Evaluated by Bland-Altman plot, the mean overestimation of CMIA compared to UHPLC-MS/MS was 53.7% for CsA and 48.1% for TAC.
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Affiliation(s)
- Shenghui Mei
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing 100045, PR China
| | - Jiaqing Wang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China
| | - Di Chen
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, 1 Dahua Road, Dongcheng District, Beijing 100005, PR China
| | - Leting Zhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China
| | - Ming Zhao
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, 1 Dahua Road, Dongcheng District, Beijing 100005, PR China
| | - Xiaoxin Tian
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, 1 Dahua Road, Dongcheng District, Beijing 100005, PR China
| | - Xin Hu
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, 1 Dahua Road, Dongcheng District, Beijing 100005, PR China.
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng District, Beijing 100050, PR China; Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing 100045, PR China.
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