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Zhao P, Qi Y. Development of a UPLC-ESI-MS/MS method for the determination of triamcinolone acetonide in human plasma and evaluation of its bioequivalence after a single intramuscular injection in healthy volunteers. Front Pharmacol 2023; 14:1223112. [PMID: 37497115 PMCID: PMC10367002 DOI: 10.3389/fphar.2023.1223112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction: Triamcinolone acetonide (TA) is commonly used in the treatment of various inflammatory conditions. To ensure its efficacy and safety, it is important to accurately determine its concentration in human plasma and evaluate its bioequivalence. In this study, an efficient ultra-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS) method was developed for the quantification of TA in human plasma after a single intramuscular injection. The internal standard used in this method was cortisone acetate (CA). Methods: TA and CA were extracted from plasma using ethyl acetate and N-hexane (4:1, v/v), separated on a C18 reverse-phase column with a mobile phase of acetonitrile-water containing 1% formic acid (55:45, v/v), and analyzed by UPLC-ESI-MS/MS. Multiple-reaction monitoring was performed using the transitions m/z 435.4→397.3 for TA and m/z 403.4→163.1 for CA. Results: The developed UPLC-ESI-MS/MS method demonstrated linearity over a concentration range of 0.53-21.20 ng/mL, with a lower limit of quantification of 0.53 ng/mL. The intra- and inter-run precision values ranged from 3.007% to 9.960% and 3.528% to 11.26%, respectively. The intra- and inter-run accuracy ranges were -1.962% to -6.577% and -3.371% to 0.348%, respectively. The matrix effect, extraction recovery, and stability of TA all met the acceptance criteria recommended by the National Medical Products Administration (NMPA) for bioassays. In healthy volunteers who received a single intramuscular injection of 80 mg of either the test or reference formulation of TA, various pharmacokinetic parameters were determined. C max was found to be 8.616 ± 1.232 and 8.285 ± 1.218 ng/mL for the test and reference formulations, respectively. T max was approximately 1.833 ± 0.243 and 1.861 ± 0.230 h. The t 1/2 was calculated to be 181.249 ± 78.585 and 201.782 ± 83.551 h. AUC 0-720 was 835.642 ± 297.209 and 830.684 ± 331.168 ng h/mL, AUC 0-∞ was 991.859 ± 355.939 and 1018.665 ± 420.769 ng h/mL for the test and reference formulations, respectively. The average relative bioavailability of TA, determined using AUC 0-720, was 105.4 ± 26.9%. Bioequivalence was evaluated through variance analysis and a double unilateral test, and the 90% confidence intervals of AUC 0-720, C max, and AUC 0-∞ were 92.8%-113.4%, 99.1%-109.1%, and 89.7%-110.9%, respectively (all p > 0.05). Discussion: These results met the bioequivalence criteria set by the NMPA, indicating that the developed UPLC-ESI-MS/MS method accurately determined TA concentrations in the plasma of healthy Chinese volunteers and that the test and reference formulations exhibited bioequivalence in these individuals.
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Affiliation(s)
- Pengfei Zhao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, China
| | - Ying Qi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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Vega-Beyhart A, Araujo-Castro M, Hanzu FA, Casals G. Cortisol: Analytical and clinical determinants. Adv Clin Chem 2023; 113:235-271. [PMID: 36858647 DOI: 10.1016/bs.acc.2022.11.005] [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: 12/27/2022]
Abstract
Cortisol, the main human glucocorticoid, is synthesized from cholesterol in the adrenal cortex and predominantly metabolized by the liver. Interpretation of quantitative results from the analysis of serum, urine and saliva is complicated by variation in circadian rhythm, response to stress as well as the presence of protein-bound and free forms. Interestingly, cortisol is the only hormone routinely measured in serum, urine, and saliva. Preanalytical and analytical challenges arise in each matrix and are further compounded by the use of various stimulation and suppression tests commonly employed in clinical practice. Although not yet included in clinical guidelines, measurement of cortisol in hair may be of interest in specific situations. Immunoassays are the most widely used methods in clinical laboratories to measure cortisol, but they are susceptible to interference from synthetic and endogenous steroids, generally producing a variable overestimation of true cortisol results, especially in urine. Analysis by mass spectrometry provides higher specificity and allows simultaneous measurement of multiple steroids including synthetic steroids, thus reducing diagnostic uncertainty. An integrated review of cortisol in various disease states is also addressed.
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Affiliation(s)
- Arturo Vega-Beyhart
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Metabolism, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Felicia A Hanzu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gregori Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Service of Biochemistry and Molecular Genetics, Hospital Clinic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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3
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Simultaneous Measurement of Cortisol, Cortisone, Dexamethasone and Additional Exogenous Corticosteroids by Rapid and Sensitive LC-MS/MS Analysis. Molecules 2022; 28:molecules28010248. [PMID: 36615443 PMCID: PMC9821861 DOI: 10.3390/molecules28010248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
The simultaneous measurement of dexamethasone and cortisol has proven the ability to increase the diagnostic performance of the overnight dexamethasone-suppression test. Furthermore, the therapeutic drug monitoring of administered corticosteroid drugs could represent a crucial tool for investigating unexpected variations of steroid hormones' circulating levels. In this work, an LC-MS/MS method for the quantification of cortisol, cortisone, dexamethasone and six additional exogenous corticosteroids in the serum/plasma matrix was developed and validated in compliance with the ISO/IEC requirements. To assess the efficiency of the validated method, serum samples of 75 patients undergoing the dexamethasone-suppression test and 21 plasma samples of patients under immunosuppressive treatment after kidney transplant were analyzed. In all dexamethasone-suppression test samples, it was possible to measure the circulating levels of cortisol, cortisone and dexamethasone. Concentrations of the latter were for all tested patients above the proposed cutoff for the dexamethasone-suppression test's results, and the cortisol concentrations showed good correlation with the ones measured by routine immunometric analysis, therefore confirming the screening outcome for all enrolled patients. Prednisone was detected and quantified in all enrolled patients, confirming the use of such a corticosteroid for immunosuppressive therapy. Thanks to these two applications, we proved the overall performance of the developed LC-MS/MS method for four target analytes. The future implementation of such an analytical tool in the clinical biochemistry laboratory's routine will guarantee a single and versatile tool for simultaneously monitoring dexamethasone-suppression-test results and corticosteroid drugs' administration.
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Patel S, Snow NH. Extraction of glucocorticoids from water into acetonitrile using polyol induced extraction with ultra performance liquid chromatography and triple quadrupole mass spectrometry (PIE-UPLC-MS-MS). J LIQ CHROMATOGR R T 2022. [DOI: 10.1080/10826076.2022.2110116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Shipra Patel
- Department of Chemistry and Biochemistry, Seton Hall University, South Orange, NJ, USA
| | - Nicholas H. Snow
- Department of Chemistry and Biochemistry, Seton Hall University, South Orange, NJ, USA
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Corticosteroid Management of Coronavirus 2019 (COVID-19) in Patients with Bilateral Adrenalectomy. Case Rep Infect Dis 2021; 2021:5856600. [PMID: 34659847 PMCID: PMC8514934 DOI: 10.1155/2021/5856600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 01/08/2023] Open
Abstract
Since the World Health Organization (WHO) announced coronavirus 2019 (COVID-19) as a pandemic in March 2020, it has been wreaking havoc across countries, affecting people's lives. Corticosteroids have proven to provide a mortality benefit in patients with COVID-19. Although dexamethasone is the most commonly used glucocorticoid and have shown to have mortality benefit in COVID-19 patients, it cannot be used in patients with adrenal insufficiency due to its lack of mineralocorticoid activity. Herein, we discuss a case of challenging corticosteroid management in a patient with COVID-19 complicated by her medical history of bilateral adrenalectomy.
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Khan MS, Ravi PR, Mullapudi TVR. Dose identification of triamcinolone acetonide for noninvasive pre-corneal administration in the treatment of posterior uveitis using a rapid, sensitive HPLC method with photodiode-array detector. Biomed Chromatogr 2021; 36:e5264. [PMID: 34653273 DOI: 10.1002/bmc.5264] [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: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/07/2022]
Abstract
Triamcinolone acetonide (TAA) is the drug of choice in the management of ocular inflammations due to its anti-inflammatory and immuno-suppressant activity. Available marketed formulations (Triesence, Trivaris, Kenalog) are in the suspension form recommended to be administered via intravitreal injection, which has many major complications. In the present study, we have designed and evaluated Hydroxypropyl-β-cyclodextrin (HP-β-CD),) based conventional formulations of TAA (aqueous suspensions) with different dose strengths to identify the dose strength required for achieving the effective concentrations in vitreous humor following pre-corneal administration of the formulations. Ocular pharmacokinetic studies of conventional formulations of triamcinolone acetonide (TAA) with different dose strengths (1 mg/30µL, 2 mg/30µL, 4 mg/30µL) were performed to identify the dose strength required to produce effective concentrations of TAA in the aqueous and vitreous humor. A rapid, sensitive, selective, accurate and precise bioanalytical method utilizing a small sampling volume (<45 µL) was developed and validated for quantification of TAA in the samples obtained from the ocular pharmacokinetic studies. Aqueous suspensions of TAA with 20% HP-β-CD produced time course profiles in the aqueous humor at all the dose strengths. However, measurable concentrations and time course of TAA in vitreous humor were achieved only with 4 mg/30µL dose strength.
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Affiliation(s)
| | - Punna Rao Ravi
- Department of Pharmacy, BITS-Pilani Hyderabad Campus, Hyderabad, India
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Huayllas MKP, Smith LM, Gallagher JC, Netzel BC, Singh RJ, Kater CE. Steroidogenesis in patients with adrenal incidentalomas: Extended steroid profile measured by liquid chromatography-mass spectrometry after ACTH stimulation and dexamethasone suppression. Clin Endocrinol (Oxf) 2021; 95:29-40. [PMID: 33598999 DOI: 10.1111/cen.14445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Describe the secretion and profile of adrenal steroids in patients with adrenal incidentalomas compared to control subjects. DESIGN, SETTING AND PARTICIPANTS A prospective study, 73 patients with adrenal incidentalomas, 21 bilateral and 52 unilateral and 34 matched controls in University Hospital. METHODS Collect fasting blood sample before and 60 min after ACTH test (250 µg IV). One week later, perform overnight 1 mg dexamethasone test. The following steroids were measured by liquid chromatography-mass spectrometry (LC-MS): pregnenolone, 17-OH pregnenolone, 17-OH progesterone, 11-deoxycorticosterone, 11-deoxyortisol, 21-deoxycortisol, corticosterone, cortisol, androstenedione and aldosterone. RESULTS Mean baseline serum cortisol was higher in incidentalomas, bilateral 361 ± 124, (range 143-665) nmol/L,(p < .0001), unilateral 268 ± 89 3.2 (range 98-507) nmol/L (p < .019) compared to controls 207 ± 100 (range 72-502) nmol/L. ACTH stimulation showed significantly higher levels in bilateral and unilateral cases compared to controls. After dexamethasone, mean serum cortisol levels suppressed in bilaterals 89 ± 69 (range 30-3) nmol/L (p < .0001), 58 ± 52 (range 16-323) nmol/L in unilateral (p < .01) compared to 26 ± 9 (range 7-46) nmol/L in controls. Mean baseline serum corticosterone was higher in bilateral 9.3 ± 4.8 (range 2.4-18.4) nmol/L (p < .005) and unilateral 7.3 ± 5.7 (range 0.1-30.3) nmol/L (p < .01) compared to controls 4.2 ± 2.4 (range 1.1-10.2) nmol/L, after ACTH stimulation significantly increased to higher levels in bilateral (p < .0002) and unilateral cases (p < .044) compared to controls. After dexamethasone, mean levels were 2.5 ± 2.6 (range 0.5-12.5) nmol/L in bilateral (p < .0006), 1.5 ± 1.6 (range 0.3-9.3) nmol/L in unilateral (p < .09) and 0.75 ± 0.46 (range 0.1-2.1) nmol/L in controls. Mean baseline serum 11-deoxycorticosterone (DOC) was higher in bilaterals 0.32 ± 0.23 (range 0.08-1.1) nmol/L (p < .03) compared to controls 0.15 ± 0.21 (range 0.08-1.1) nmol/L. ACTH stimulation increased levels to 3.27 ± 1.72 (range 0.5-7.4) nmol/L in bilateral cases compared to controls 1.369 ± 1.53 (range 0.1-7.1) nmol/L (p < .0001). Dexamethasone decreased levels to baseline (p ns). There were significant differences in serum 21-deoxycortisol (p < .0002) and serum pregnenolone (p < .004) only after ACTH stimulation. CONCLUSIONS There is increased activity in several steroid biosynthesis pathways and higher steroid levels in bilateral compared to unilateral cases and evidence of hypercortisolism in 30% unilateral and 62% of bilateral incidentalomas.
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Affiliation(s)
- Martha K P Huayllas
- Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, UNIFESP- EPM, Federal University of São Paulo, São Paulo, Brasil
| | - Lynette M Smith
- Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Brian C Netzel
- Laboratory and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ravinder J Singh
- Laboratory and Pathology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Claudio E Kater
- Adrenal and Hypertension Unit, Division of Endocrinology and Metabolism, Department of Medicine, UNIFESP- EPM, Federal University of São Paulo, São Paulo, Brasil
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Chan CY, Ng SW, Ching CK, Mak TWL. Detection of 28 Corticosteroids in Pharmaceutical and Proprietary Chinese Medicinal Products Using Liquid Chromatography-Tandem Mass Spectrometry. J Chromatogr Sci 2021; 59:548-554. [PMID: 33479748 DOI: 10.1093/chromsci/bmaa140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 11/13/2022]
Abstract
With their potent anti-inflammatory effects, corticosteroids are popular adulterants in illicit health products for allergies, dermatitis and pain control. Their illegal supply over the counter is also a common practice for similar conditions. Prolonged, unsupervised usage of corticosteroids often leads to severe adverse effects including Cushing syndrome, adrenal insufficiency and immunosuppression. Confirming clinical suspicion of unsupervised corticosteroid usage is challenging. Apart from evaluating the adrenal function, identifying the concerned drug is the most direct proof of its consumption. While detecting corticosteroids or their metabolites in biological specimens is convincing evidence of their usage, such approach is analytically difficult. More importantly, this approach would not be useful if the patient has stopped taking the drug for some time-a situation that is often encountered clinically. We advocate a more direct approach by measuring corticosteroids in suspicious medicinal products. In the current study, a liquid chromatography-tandem mass spectrometry method for simultaneous detection of 28 corticosteroids in pharmaceutical and proprietary Chinese medicine products was developed and validated for the purpose. The method was applied to 388 cases of suspected unsupervised corticosteroids usage. Among 1,000 products tested, corticosteroids were found in 276 of them and confirmed the clinical suspicion.
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Affiliation(s)
- Candace Yim Chan
- Hospital Authority Toxicology Reference Laboratory, Room 1414, Block G, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Sau Wah Ng
- Hospital Authority Toxicology Reference Laboratory, Room 1414, Block G, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Chor Kwan Ching
- Hospital Authority Toxicology Reference Laboratory, Room 1414, Block G, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
| | - Tony Wing Lai Mak
- Hospital Authority Toxicology Reference Laboratory, Room 1414, Block G, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong
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Chen YL, Wang W, Gatien Ngounou Wetie A, Shi L, Eddy J, John Lin ZP, Sunkaraneni S. An Ultrasensitive LC-APPI-MS/MS Method for Simultaneous Determination of Ciclesonide and Active Metabolite Desisobutyryl-Ciclesonide in Human Serum and Its Application to a Clinical Study. J Appl Lab Med 2021; 5:41-53. [PMID: 31662413 DOI: 10.1373/jalm.2019.029397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 05/28/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The development of more efficient drug delivery devices for ciclesonide inhalation products requires an ultrasensitive bioanalytical method to measure systematic exposure of ciclesonide (CIC) and its active metabolite desisobutyryl-ciclesonide (des-CIC) in humans. METHOD Serum sample was extracted with 1-chlorobutane. A reversed-phase liquid chromatography coupled with atmospheric pressure photoionization-tandem mass spectrometry (LC-APPI-MS/MS) method was used for quantification of 1-500 pg/mL for both analytes in a 0.500-mL serum. The analysis time was 4.7 min/injection. CIC-d11 and des-CIC-d11 were used as the internal standards. RESULTS Calibration curves showed good linearity (r2 > 0.99) for both analytes. This novel method was precise and accurate with interassay precision and accuracy of all within 9.6% CV and ± 4.0% bias for regular QC samples. Extraction recovery was approximately 85% for both analytes. Serum samples are stable for 3 freeze-thaw cycles, 24 h at bench top, and up to 706 days at both -20 °C and -70 °C. This method was successfully used to support a pharmacokinetic (PK) comparison between the inhalation suspensions and an inhalation aerosol of ciclesonide in healthy participants. The method robustness was also supported by the good incurred sample reanalysis reproducibility. CONCLUSION APPI, a highly selective and sensitive ionization source, made possible for quantifying CIC and des-CIC with a lower limit of quantification (LLOQ) of 1 pg/mL in human serum by LC-MS/MS. A 10-fold sensitivity improvement from the most sensitive reported method (LLOQ, 10 pg/mL) is essential to fully characterize the PK profiles of CIC and des-CIC in support of the clinical development of the ciclesonide-related medications for patients.
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Affiliation(s)
- Yu-Luan Chen
- Clinical Pharmacology, Sunovion Pharmaceuticals, Marlborough, MA
| | - Weimin Wang
- Bioanalytical Services, Frontage Laboratories, Exton, PA
| | | | - Lei Shi
- Clinical Pharmacology, Sunovion Pharmaceuticals, Marlborough, MA
| | - John Eddy
- Clinical Pharmacology, Sunovion Pharmaceuticals, Marlborough, MA
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Gant Kanegusuku A, Araque KA, Nguyen H, Wei B, Hosseini S, Soldin SJ. The effect of specific binding proteins on immunoassay measurements of total and free thyroid hormones and cortisol. Ther Adv Endocrinol Metab 2021; 12:2042018821989240. [PMID: 33552466 PMCID: PMC7844449 DOI: 10.1177/2042018821989240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Immunoassay (IA) measurements of thyroid hormones have previously given inaccurate results of triiodothyronine (T3), free triiodothyronine (FT3), and free thyroxine (FT4) when concentrations of TBG are low. We evaluate the hypothesis that abnormal concentrations of specific binding proteins (BPs) affect IA measurements and provide results which might misguide the diagnosis and treatment of patients. This study assesses IAs for the measurement of T3, FT3, and cortisol when levels of TBG and CBG are high or low. Comparisons are made between IA and LC-MS/MS. METHODS Serum or plasma samples with high (>95th percentile, n = 25) or low (<5th percentile, n = 27) concentrations of BP were collected. The concentrations of T3, FT3, and cortisol were measured by validated IA and liquid chromatography tandem mass spectrometry (LC-MS/MS) methods. Spearman correlation and Wilcoxon matched-pairs signed rank analyses were used to compare the two methods. RESULTS When TBG levels are <5th percentile, the differences between the IA and LC-MS/MS results for T3 and FT3 are statistically significant (T3, p = 0.0011; FT3, p = 0.0003). When CBG levels are >95th percentile, the difference between the IA and LC-MS/MS measurements of cortisol is statistically significant (p = <0.0001). CONCLUSION Abnormal BP concentrations appear to affect the accuracy of IA measurements of T3, FT3, and cortisol. The population of patients with either high or low levels of BPs is significant. Our samples reflect that 65% of women aged between 15 and 49 years are taking oral contraceptives in the US, and thus have elevated levels of BPs. In this group, IA results for cortisol are falsely low. Our samples reflect that patients with protein losing diseases have low BP concentrations. Among a group with renal complications, IA measurements of T3 are overestimated, while those of FT3 are underestimated. Are the Food and Drug Administration and diagnostic companies adequately assessing the accuracy of IA tests?
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Affiliation(s)
- Anastasia Gant Kanegusuku
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Katherine A. Araque
- Endocrinology Pituitary Institute, Pacific Neuroscience Institute, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Hung Nguyen
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Bin Wei
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Saman Hosseini
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steven J. Soldin
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, 10 Center Drive, Building 10, Bethesda, MD 20892–0001, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University, Washington, DC, USA
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Casals G, Hanzu FA. Cortisol Measurements in Cushing's Syndrome: Immunoassay or Mass Spectrometry? Ann Lab Med 2020; 40:285-296. [PMID: 32067427 PMCID: PMC7054699 DOI: 10.3343/alm.2020.40.4.285] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/20/2019] [Accepted: 02/07/2020] [Indexed: 11/19/2022] Open
Abstract
Determination of cortisol levels in the urine (24 hours urine free cortisol), saliva (late-night), or serum (total cortisol after dexamethasone suppression) is recommended to screen for Cushing's syndrome (CS). This review focuses on the differences between the frequently used cortisol-antibody immunoassay-based methods and the highly specific mass-spectrometry-based methods that are progressively being employed in clinical laboratories for CS screening. The particular characteristics of cortisol metabolism and the lack of specificity of the immunoassays cause marked differences between both methods that are in turn highly dependent on the biological matrix, in which the cortisol is measured. Understanding the origin of these differences is essential for the interpretation of these results. Although cross-reactivity with endogenous steroids leads to grossly inaccurate results of immunoassay measurements of cortisol in the saliva and urine, preliminary evidence suggests that the clinical sensitivity of CS screening using immunoassays may be similar to CS screening using mass spectrometry. However, mass spectrometry offers more accurate results and considerably reduced variation across laboratories, while avoiding false-positive results. Moreover, mass spectrometry can overcome some common diagnostic challenges, such as identification of exogenous corticosteroids or simultaneous assessment of appropriate dexamethasone levels in suppression tests. Further, comprehensive mass spectrometry-based profiling of several steroid metabolites may be useful for discriminating among different subtypes of CS. Finally, this review discusses the main preanalytical factors that could cause variations in cortisol measurements and their influence on the reliability of the results.
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Affiliation(s)
- Gregori Casals
- Department of Biochemistry and Molecular Genetics, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centrode Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), ISCIII, Madrid, Spain.
| | - Felicia Alexandra Hanzu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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12
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Cambos S, Chanson P, Tabarin A. Analysis of steroid profiles by mass spectrometry: A new tool for exploring adrenal tumors? ANNALES D'ENDOCRINOLOGIE 2020; 82:36-42. [PMID: 33278379 DOI: 10.1016/j.ando.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The assay of multiple steroids by mass spectrometry coupled with chromatography, combined with data analysis using an artificial intelligence approach, has become more widely accessible in recent years. Multiple applications for this technology exist for the study of adrenocortical tumors. Taking advantage of the capacity of malignant cortical tumor secretion of non-bioactive precursors, it provides an additional diagnostic approach that can point to the nature of a tumor. These encouraging perspectives have been based to date only on pilot retrospective studies. However, this has changed in 2020 with the publication of data from the EURINE-ACT study. This very large prospective European study provided more nuanced evidence for the benefit of combining the measurement of a panel of steroids with essential imaging tools. This study also facilitated our understanding and provided more precise characterisation of autonomous steroid secretion, particularly in the case of sublinical cortisol-secreting adrenocortical adenomas. This article will focus on our current knowledge on the potential utility of mass spectrometry for diagnosis of both the nature of an adrenal tumors and their secretion.
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Affiliation(s)
- Sophie Cambos
- Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Bordeaux, Hôpital Haut Lévêque, 33600 Pessac, France.
| | - Philippe Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, Le Kremlin-Bicêtre, France
| | - Antoine Tabarin
- Service d'Endocrinologie, Diabétologie et Maladies Métaboliques, CHU de Bordeaux, Hôpital Haut Lévêque, 33600 Pessac, France; Inserm U1215, Neurocentre Magendie, Université de Bordeaux, 146, Rue Leo-Saignat, 33076 Bordeaux Cedex, France
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Yao Q, Guo Y, Xue J, Kong D, Li J, Tian X, Hao C, Zhou T. Development and validation of a LC-MS/MS method for simultaneous determination of six glucocorticoids and its application to a pharmacokinetic study in nude mice. J Pharm Biomed Anal 2020; 179:112980. [DOI: 10.1016/j.jpba.2019.112980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 01/18/2023]
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Esposito MC, Santos ALA, Bonfilio R, de Araújo MB. A Critical Review of Analytical Methods in Pharmaceutical Matrices for Determination of Corticosteroids. Crit Rev Anal Chem 2019; 50:111-124. [PMID: 30869528 DOI: 10.1080/10408347.2019.1581050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Corticosteroids are a class of hormones released by the adrenal cortex, which includes glucocorticoids and mineralocorticoids. Glucocorticoids have an important role in the metabolism of carbohydrates, proteins and calcium and effective anti-inflammatory and immunosuppressive activity. Due to their intense immunomodulatory and anti-inflammatory activity, glucocorticoids are used in the treatment of various inflammatory, malignant, allergic conditions such as rhinitis, asthma, dermatological, rheumatic, ophthalmic and neurological diseases, as well as after organ transplants. They are the most widely prescribed drugs in the world. The objective of this review is to provide an overview of the analytical methods in pharmaceutical matrices for determination of corticosteroids. In this study, the predominance of liquid chromatography methods for the analysis of corticosteroids from pharmaceutical products is evident for both liquid and semisolid dosage forms as well as for solids. The same can be said for topical, oral and parenteral formulations. Methods such as spectrophotometry are also used, but given the advantages of chromatographic methods such as better selectivity and sensitivity, they have become the choice for analysis of these drugs, however, most methods still do not meet the credentials of "green chemistry."
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Affiliation(s)
- Milena Carla Esposito
- Department of Food and Drug Administration, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Rudy Bonfilio
- Department of Food and Drug Administration, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Magali Benjamim de Araújo
- Department of Food and Drug Administration, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Ibrahim H, Ibrahim M, Temerk Y. A novel megestrol acetate electrochemical sensor based on conducting functionalized acetylene black-CeO 2NPs nanohybrids decorated glassy carbon microspheres. Talanta 2019; 200:324-332. [PMID: 31036192 DOI: 10.1016/j.talanta.2019.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 11/18/2022]
Abstract
For the first time, megestrol acetate (MGA), a synthetic progestin with therapeutic use in breast cancer, is electrochemically studied to propose a new electroanalytical alternative for its detection in real samples. In the present work, a novel electrochemical sensor based on functionalized acetylene black-CeO2NPs nanohybrids modified glassy carbon microspheres paste electrode (FAB-CeO2NPs/GCMPE) was successfully fabricated and used for sensitive determination of MGA. The modified electrode has been characterized using scanning electron microscope (SEM), cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The electrocatalytic reduction of MGA using FAB-CeO2NPs/GCMPE was carried out via CV and square wave voltammetry (SWV). By employing FAB-CeO2NPs/GCMPE, the SWV signal of MGA reduction was 8 fold higher than the bare GCMPE. A wide concentration range from 4.20 × 10-8 to 1.13 × 10-6 M with the low LOD of 1.30 nM for MGA was achieved. The practical analytical utilities of the prospective FAB-CeO2NPs/GCMPE sensor were demonstrated successfully by the detection of MGA in Megace tablets, human serum and urine samples obtained from healthy and patient volunteers after oral administration of 160 mg Megace tablets. HPLC method was also developed for comparison with the electroanalytical method.
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Affiliation(s)
- Hossieny Ibrahim
- Chemistry Department, Faculty of Science, Assiut University, Assiut, Egypt.
| | - Mohamed Ibrahim
- Department of Clinical Pharmacy Research, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Yassien Temerk
- Chemistry Department, Faculty of Science, Assiut University, Assiut, Egypt.
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Karatt TK, Sayed R, Nalakath J, Perwad Z, Albert PH, Abdul Khader KK. Separation and identification of the epimeric doping agents - Dexamethasone and betamethasone in equine urine and plasma: A reversed phase chiral chromatographic approach. Steroids 2018; 140:77-82. [PMID: 30296548 DOI: 10.1016/j.steroids.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/09/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022]
Abstract
Chirality is one of the most important considerations when controlling doping. The epimeric corticosteroids dexamethasone and betamethasone are significantly potent and long-acting, and they are highly abused in equestrian sports. The scope of this study was to develop a simple and reliable analytical method for simultaneously identifying and separating regularly abused co-eluting corticosteroids in equine urine and plasma. In this paper, we present a simple and rapid method for the chiral separation and identification of epimeric mixtures of dexamethasone and betamethasone using a Thermo Q Exactive high resolution accurate mass spectrometer. The high resolution accurate mass spectrometer system provided extremely high sensitivity, enabling detection of each isomer at a very low concentration from complex biological matrices. Chromatographic separation was performed using amylose and cellulose chiral columns. Reversed phase media showed very good potential for providing a successful chiral resolution in LC-MS analysis. This study also focused on optimizing the mobile phase for elution strength, nature of the organic modifier, additives, and column temperature.
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Affiliation(s)
- Tajudheen K Karatt
- Equine Forensic Unit, Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates
| | - Ramy Sayed
- Equine Forensic Unit, Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates
| | - Jahfar Nalakath
- Equine Forensic Unit, Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates
| | - Zubair Perwad
- Equine Forensic Unit, Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates
| | - Peter H Albert
- Equine Forensic Unit, Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates
| | - K K Abdul Khader
- Equine Forensic Unit, Central Veterinary Research Laboratory, PO Box 597, Dubai, United Arab Emirates.
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17
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Karatt TK, Nalakath J, Perwad Z, Albert PH, Abdul Khader KK, Syed Ali Padusha M, Laya S. Mass spectrometric method for distinguishing isomers of dexamethasone via fragment mass ratio: An HRMS approach. JOURNAL OF MASS SPECTROMETRY : JMS 2018; 53:1046-1058. [PMID: 30098588 DOI: 10.1002/jms.4279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
The major challenge in identifying dexamethasone, betamethasone, and paramethasone from a mixture of these corticosteroids is difficulty in achieving an efficient separation. In this study, we aimed to develop an efficient technique to identify these co-eluting isomers based on the mass spectral patterns of them and their corresponding phase II metabolites after electrospray ionization. Fragmentation pathways in tandem mass spectrometry revealed acceptable specificity within the groups of conjugates. The method was validated using individual isomers and mixtures at various compositions. The effects of concentration and collision energies on fragmentation patterns were also studied extensively. Matrix-fortified equine urine and plasma samples were also included so that matrix effects and interferences on fragmentation ratios could be elucidated. Preliminary results using biological samples demonstrated the suitability of this analytical strategy for direct measurement from their fragmentation patterns. Possible fragmentation pathways for each isomer were proposed.
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Affiliation(s)
- Tajudheen K Karatt
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
- Post Graduate and Research Department of Chemistry, Jamal Mohamed College, Bharathidasan University, Tiruchirapalli, India
| | - Jahfar Nalakath
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | - Zubair Perwad
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | - Peter H Albert
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | | | - Mohamedkhan Syed Ali Padusha
- Post Graduate and Research Department of Chemistry, Jamal Mohamed College, Bharathidasan University, Tiruchirapalli, India
| | - Saraswathy Laya
- Department of Chemistry, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
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18
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Kamalov MI, Đặng T, Petrova NV, Laikov AV, Luong D, Akhmadishina RA, Lukashkin AN, Abdullin TI. Self-assembled nanoformulation of methylprednisolone succinate with carboxylated block copolymer for local glucocorticoid therapy. Colloids Surf B Biointerfaces 2018; 164:78-88. [DOI: 10.1016/j.colsurfb.2018.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 02/07/2023]
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Hawley JM, Owen LJ, Debono M, Newell-Price J, Keevil BG. Development of a rapid liquid chromatography tandem mass spectrometry method for the quantitation of serum dexamethasone and its clinical verification. Ann Clin Biochem 2018. [PMID: 29534610 DOI: 10.1177/0004563218766566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Measurement of serum dexamethasone during the overnight dexamethasone-suppression test has been recommended to reduce false-positive results when investigating Cushing's syndrome or increasingly commonly found adrenal incidentalomas. Despite this, there remains a paucity of well-validated dexamethasone methods currently available. Here, we describe the development of a rapid and sensitive liquid chromatography tandem mass spectrometry serum dexamethasone assay and verify its utility in a cohort of postmenopausal females. Method Isotopically labelled internal standard was added to samples prior to supported liquid extraction. Extracts were analysed using liquid chromatography tandem mass spectrometry in the positive electrospray ionization mode. Multiple reaction monitoring was used to detect dexamethasone and its corresponding internal standard transitions. Normal healthy postmenopausal women ( n = 95) were recruited and underwent an overnight dexamethasone suppression test, with serum dexamethasone and cortisol measurements at 09:00 after administration of oral dexamethasone 1 mg at 23:00 the night before. Results Mean intra- and inter-assay imprecision were 4.1% and 2.9%, respectively, for dexamethasone concentrations of 1.5, 6.0 and 12.0 nmol/L. Matrix effects were found to be negligible at 106-109% with recovery ranging from 96 to 100%. The limit of quantitation was 0.25 nmol/L, and structural analogue analysis proved the method to be robust against interferences. Applying a serum dexamethasone cut-off of >3.3 nmol/L was associated with a serum cortisol ≤50 nmol/L in 84/95 individuals. Conclusion We have developed a sensitive and robust liquid chromatography tandem mass spectrometry method for the quantitation of serum dexamethasone. The method can be used to identify false-positive results during the overnight dexamethasone suppression test or for pharmacokinetic studies.
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Affiliation(s)
- James M Hawley
- 1 Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK
| | - Laura J Owen
- 1 Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK.,2 Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Miguel Debono
- 3 Academic Unit of Endocrinology, University of Sheffield, Sheffield, UK
| | - John Newell-Price
- 3 Academic Unit of Endocrinology, University of Sheffield, Sheffield, UK
| | - Brian G Keevil
- 1 Department of Clinical Biochemistry, Wythenshawe Hospital, Manchester NHS Foundation Trust, Manchester, UK.,2 Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
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Dickson RR, Reid JM, Nicholson WT, Lamer TJ, Hooten WM. Corticosteroid and Cortisol Serum Levels Following Intra-articular Triamcinolone Acetonide Lumbar Facet Joint Injections. Pain Pract 2018; 18:864-870. [DOI: 10.1111/papr.12686] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/18/2018] [Accepted: 02/02/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Rozalin R. Dickson
- Department of Anesthesiology and Perioperative Medicine; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
- Mayo Graduate School of Medicine; Rochester Minnesota U.S.A
| | - Joel M. Reid
- Division of Medical Oncology; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
- Division of Molecular Pharmacology and Experimental Therapeutics; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
| | - Wayne T. Nicholson
- Department of Anesthesiology and Perioperative Medicine; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
| | - Tim J. Lamer
- Department of Anesthesiology and Perioperative Medicine; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
- Division of Pain Medicine; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
| | - W. Michael Hooten
- Department of Anesthesiology and Perioperative Medicine; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
- Division of Pain Medicine; Mayo Clinic College of Medicine; Rochester Minnesota U.S.A
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21
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Lamer TJ, Dickson RR, Gazelka HM, Nicholson WT, Reid JM, Moeschler SM, Hooten WM. Serum Triamcinolone Levels following Cervical Interlaminar Epidural Injection. Pain Res Manag 2018; 2018:8474127. [PMID: 29755622 PMCID: PMC5883975 DOI: 10.1155/2018/8474127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/25/2018] [Indexed: 11/18/2022]
Abstract
Background Cervical interlaminar epidural steroid injections (ESIs) are commonly performed procedures to treat painful cervical radiculopathy, but little is known about the systemic absorption and serum levels of steroids following injection. The primary objective of this study was to investigate the pharmacokinetics of fluoroscopy-guided cervical epidural-administered triamcinolone acetonide in a cohort of patients with cervical radicular pain seeking treatment in a pain medicine clinic. Methods The study cohort included eight patients undergoing a fluoroscopically guided C7-T1 interlaminar ESI at a pain medicine specialty clinic. Blood was collected prior to the ESI and on days 1, 2, 4, 6, 8, 14, 21, 28, 35, and 42 following the injection. The sample extract was analyzed by tandem mass spectrometry. Results The terminal elimination half-life of cervical epidural-administered triamcinolone in a noncompartmental analysis was 219 hours. In the noncompartmental analysis, peak triamcinolone concentrations of 5.4 ng/mL were detected within 22.1 hours after administration. Conclusions The pharmacokinetics of cervical epidural-administered triamcinolone is consistent with our previous study of lumbar ESI, demonstrating that the elimination half-life is longer than that which has been reported following intravenous triamcinolone. The elimination half-life was shorter following cervical ESI than that which has been reported following lumbar ESI.
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Affiliation(s)
- Tim J. Lamer
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rozalin R. Dickson
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Halena M. Gazelka
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Wayne T. Nicholson
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Joel M. Reid
- Division of Medical Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Susan M. Moeschler
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - W. Michael Hooten
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Pain Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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22
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Kropff J, Choudhary P, Neupane S, Barnard K, Bain SC, Kapitza C, Forst T, Link M, Dehennis A, DeVries JH. Accuracy and Longevity of an Implantable Continuous Glucose Sensor in the PRECISE Study: A 180-Day, Prospective, Multicenter, Pivotal Trial. Diabetes Care 2017; 40:63-68. [PMID: 27815290 DOI: 10.2337/dc16-1525] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/17/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is known that continuous glucose monitoring (CGM) systems can lower mean glucose compared with episodic self-monitoring of blood glucose. Implantable CGM systems may provide additional benefits. RESEARCH DESIGN AND METHODS We studied the Eversense (Senseonics Inc.) implantable CGM sensor in 71 participants aged 18 years and older with type 1 and type 2 diabetes in a 180-day multinational, multicenter pivotal trial. Participants used the CGM system at home and in the clinic. CGM accuracy was assessed during eight in-clinic visits with the mean absolute relative difference (MARD) for venous reference glucose values >4.2 mmol/L as the primary end point. Secondary end points included Clarke Error Grid Analysis and alarm performance. The primary safety outcome was device-related serious adverse events. This trial is registered with ClinicalTrials.gov, number NCT02154126. RESULTS The MARD value against reference glucose values >4.2 mmol/L was 11.1% (95% CI 10.5, 11.7). Clarke Error Grid Analysis showed 99.2% of samples in the clinically acceptable error zones A and B. Eighty-one percent of hypoglycemic events were detected by the CGM system within 30 min. No device-related serious adverse events occurred during the study. CONCLUSIONS Our results indicate the safety and accuracy of this new type of implantable CGM system and support it as an alternative for transcutaneous CGM.
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Affiliation(s)
- Jort Kropff
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Sankalpa Neupane
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K
| | | | - Steve C Bain
- Joint Clinical Research Facility, Swansea University, Swansea, U.K
| | | | | | - Manuela Link
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - J Hans DeVries
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Chen MY, Tang YJ, Wang YC, Wang CZ, Yuan CS, Chen Y, Tan ZR, Huang WH, Zhou HH. Quantitative determination of betamethasone sodium phosphate and betamethasone dipropionate in human plasma by UPLC-MS/MS and a bioequivalence study. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2016; 8:3550-3563. [PMID: 27695531 PMCID: PMC5042352 DOI: 10.1039/c6ay00202a] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The compound medicine of betamethasone sodium phosphate (BSP) and betamethasone dipropionate (BDP) is widely used for diverse glucocorticoid-sensitive acute and chronic diseases such as asthma, rheumatoid arthritis and systemic lupus erythematosus. It will be useful and beneficial to validate sensitive method for the determination of BSP, BDP and their metabolites for their pharmacokinetic study. Hereby, an ultra-high pressure liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) has been validated for the determination of BSP, BDP and their metabolites betamethasone (BOH), betamethasone 17-monodipropionate (B17P) and betamethasone 21-monodipropionate (B21P) in human plasma. Liquid-liquid extraction with ether and n-hexane (v/v, 4:1) was used for sample preparation of BDP, BOH, B17P and B21P with beclomethasone dipropionate as internal standard (IS), while solid phase extraction was adopted for sample preparation of BSP using prednisolone as IS. The chromatographic separation was performed on a Hypurity C18 column (150 mm×2.1 mm, 5 μm) for BOH, BDP, B21P and B17P, and a Luna C18 (2) column (150 mm×2.0 mm, 5 μm) for BSP. Electrospray ionization interfaced with positive multiple reaction monitoring (MRM) scan mode was used for mass spectrometric detection. The standard calibration curves were linear within the range of 2.525 × 10-9-403.9 × 10-9 mol·dm-3 for BSP, 0.125 × 10-9-55.81 × 10-9 mol·dm-3 for BDP, 0.278 × 10-9-74.95 × 10-9 mol·dm-3 for BOH, 0.098 × 10-9-4.688 × 10-9 mol·dm-3 for B17P and 0.226 × 10-9-5.411 × 10-9 mol·dm-3 for B21P, respectively. The validated method was successfully applied to a bioequivalence study in 23 healthy subjects after they were injected with this compound medicine BSP and BDP.
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Affiliation(s)
- Man-Yun Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
| | - Yong-Jun Tang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
| | - Yi-Cheng Wang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
| | - Chong-Zhi Wang
- Tang Center for Herbal Medicine Research, The Pritzker School of Medicine, University of Chicago; 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA
| | - Chun-Su Yuan
- Tang Center for Herbal Medicine Research, The Pritzker School of Medicine, University of Chicago; 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
| | - Zhi-Rong Tan
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
| | - Wei-Hua Huang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
- Tang Center for Herbal Medicine Research, The Pritzker School of Medicine, University of Chicago; 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637, USA
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, China
- Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Central South University, Changsha 410078, China
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Kauhanen D, Sysi-Aho M, Koistinen KM, Laaksonen R, Sinisalo J, Ekroos K. Development and validation of a high-throughput LC-MS/MS assay for routine measurement of molecular ceramides. Anal Bioanal Chem 2016; 408:3475-83. [PMID: 26922344 DOI: 10.1007/s00216-016-9425-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/09/2016] [Accepted: 02/15/2016] [Indexed: 12/16/2022]
Abstract
Monitoring the levels of the ceramides (Cer) d18:1/16:0, Cer d18:1/18:0, Cer d18:1/24:0, and Cer d18:1/24:1 and ratios thereof in human plasma empowers the prediction of fatal outcome of coronary artery disease (CAD). We describe a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) methodology for clinical-scaled measurement of the four distinct ceramides. Rapid plasma precipitation was accomplished in 96-well format. Excellent extraction recoveries in the range of 98-109% were achieved for each ceramide. Addition of corresponding D7-labeled ceramide standards facilitated precise quantification of each plasma ceramide species utilizing a novel short 5-min LC-MS/MS method. Neither matrix interference nor carryover was observed. Robust intra- and inter-assay accuracy and precision <15% at five different concentrations were obtained. Linear calibration lines with regressions, R(2) > 0.99, were achieved for all analytes. Short-term bench top, long-term plasma, and extract stability demonstrated that the distinct ceramides were stable in the conditions evaluated. The validity of the methodology was demonstrated by determining the precise ceramide concentrations in a small CAD case-control study. Thus, our LC-MS/MS methodology features simple sample preparation and short analysis time for accurate quantification of Cer d18:1/16:0, Cer d18:1/18:0, Cer d18:1/24:0, and Cer d18:1/24:1, designed for routine analysis.
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Affiliation(s)
| | | | | | | | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, 00029 HUS, Helsinki, Finland
| | - Kim Ekroos
- Zora Biosciences, Biologinkuja 1, 02150, Espoo, Finland.
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Suneetha A, Raja Rajeswari K. A high throughput flow gradient LC-MS/MS method for simultaneous determination of fingolimod, fampridine and prednisone in rat plasma, application to in vivo perfusion study. J Pharm Biomed Anal 2016; 120:10-8. [PMID: 26686828 DOI: 10.1016/j.jpba.2015.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/16/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022]
Abstract
In this study a selective and high throughput liquid chromatography-mass spectrometry method was developed and validated for the simultaneous quantification of fingolimod (FLD), fampridine (FMP) and prednisone (PDN) in rat plasma using imipramine (IMP) as internal standard (ISTD). In this LC-MS method, following protein precipitation extraction (PPE), the analytes and ISTD were run on XBridge C18 column (150×4.6mm, 5μm) using gradient mobile phase consisting of 5mM ammonium formate in water (pH 9.0) and acetonitrile in a flow gradience program. The drug precursor and product ions were monitored on a triple quadrupole instrument that was operated in positive ionization mode. The method was validated over a concentration range of 0.1-100ng/mL for all the three analytes with relative recoveries ranging from 69 to 82%. The intra and inter batch precision (% CV) across four validation runs were less than 13.4%. The accuracy determined at four QC levels (LLOQ, LQC, MQC and HQC) were within ±6.5% of CV values. The method proved to be highly reproducible and sensitive that was successfully applied in a pharmacokinetic study after single dose oral administration to the rats and also in perfusion study sample analysis.
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Affiliation(s)
- A Suneetha
- Department of Pharmaceutical Analysis, Hindu College of Pharmacy, Amaravathi Road, Guntur 522 002, Andhra Pradesh, India.
| | - K Raja Rajeswari
- College of Pharmaceutical Sciences, Acharya Nagarjuna University, Nagarjuna Nagar, Guntur 522510, Andhra Pradesh, India
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Chassot JM, Ferreira LM, Gomes FP, Cruz L, Tasso L. Stability-indicating RP-HPLC method for determination of beclomethasone dipropionate in nanocapsule suspensions. BRAZ J PHARM SCI 2015. [DOI: 10.1590/s1984-82502015000400006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
abstract A simple stability-indicating RP-HPLC/UV method was validated for determination of beclomethasone dipropionate (BD) in nanocapsule suspensions. Chromatographic conditions consisted of a RP C18column (250 mm x 4.60 mm, 5 µm, 110 Å), using methanol and water (85:15 v/v) as mobile phase at 1.0 mL/min with UV detection at 254 nm. The calibration curve was found to be linear in the concentration range of 5.0-25.0 µg/mL with a correlation coefficient > 0.999. Precision was demonstrated by a relative standard deviation lower than 2.0%. Accuracy was assessed by the recovery test of BD from nanocapsules (98.03% to 100.35%). Specificity showed no interference from the components of nanocapsules or from the degradation products derived from acid, basic and photolytic conditions. In conclusion, the method is suitable to be applied to assay BD in bulk drug and in nanocapsules, and it can be employed to study stability and degradation kinetics.
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Taylor AE, Keevil B, Huhtaniemi IT. Mass spectrometry and immunoassay: how to measure steroid hormones today and tomorrow. Eur J Endocrinol 2015; 173:D1-12. [PMID: 25877990 DOI: 10.1530/eje-15-0338] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 11/08/2022]
Abstract
The recent onslaught of mass spectrometry (MS) to measurements of steroid hormones, including demands that they should be the only acceptable method, has confused clinicians and scientists who have relied for more than 40 years on a variety of immunoassay (IA) methods in steroid hormone measurements. There is little doubt that MS methods with their superior specificity will be the future method of choice in many clinical and research applications of steroid hormone measurement. However, the majority of steroid measurements are currently, and will continue to be, carried out using various types of IAs for several reasons, including their technical ease, cost and availability of commercial reagents. Speedy replacement of all IAs with MS is an unrealistic and unnecessary goal, because the availability of MS measurements is limited by cost, need of expensive equipment, technical demands and lack of commercial applications. Furthermore, IAs have multiple well-known advantages that vindicate their continuing use. The purpose of this article is to elucidate the advantages and limitations of the MS and IA techniques from two angles, i.e. promotion of MS and defence of IA. The purpose of the text is to give the reader an unbiased view about the current state and future trends of steroid analysis and to help him/her choose the correct assay method to serve his/her diagnostic and research needs.
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Affiliation(s)
- Angela E Taylor
- School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland
| | - Brian Keevil
- School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland
| | - Ilpo T Huhtaniemi
- School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland School of MedicineCentre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UKDepartment of Clinical BiochemistryManchester Academic Health Science Centre, University Hospital of S Manchester, The University of Manchester, Manchester, UKDepartment of Surgery and CancerImperial College London, Institute of Reproductive and Developmental Biology, Hammersmith Campus, London W12 0NN, UKDepartment of PhysiologyInstitute of Biomedicine, University of Turku, 20520 Turku, Finland
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Simultaneous determination of triamcinolone acetonide palmitate and triamcinolone acetonide in beagle dog plasma by UPLC-MS/MS and its application to a long-term pharmacokinetic study of triamcinolone acetonide palmitate lipid emulsion injection. J Pharm Biomed Anal 2015; 104:105-11. [DOI: 10.1016/j.jpba.2014.11.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/08/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022]
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Banda J, Lakshmanan R, Vvs SP, Gudla SP, Prudhivi R. A highly sensitive method for the quantification of fludrocortisone in human plasma using ultra-high-performance liquid chromatography tandem mass spectrometry and its pharmacokinetic application. Biomed Chromatogr 2015; 29:1213-9. [PMID: 25611194 DOI: 10.1002/bmc.3410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 11/12/2022]
Abstract
A simple and high sensitive ultra-high-performance liquid chromatography tandem mass spectrometry method for the determination of fludrocortisone in human plasma was developed and validated as per guidelines. The analyte and internal standard (IS), fludrocortisone-d5 , were extracted from human plasma via liquid-liquid extraction using tert-butyl methyl ether. The chromatographic separation was achieved on a Chromolith RP18e column using a mixture of acetonitrile and 2 mm ammonium formate (70:30, v/v) as the mobile phase at a flow rate of 0.7 mL/min. Quantitation was performed on a triple quadrupole mass spectrometer employing electrospray ionization technique, operating in multiple reaction monitoring and positive ion mode. The precursors to product ion transitions monitored for fludrocortisone and IS were m/z 381.2 → 343.2 and 386.2 → 348.4, respectively. The assay was validated with linear range of 40-3000 pg/mL. The intra- and inter-day precisions (relative standard deviation) were within 0.49-7.13 and 0.83-5.87%, respectively. The proposed method was successfully applied to pharmacokinetic studies in humans.
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Affiliation(s)
- Jagadeesh Banda
- Bioanalytical Department, QPS Bioserve India Pvt. Ltd, Balanagar, Hyderabad-, 500 037, India
| | - Ramalingam Lakshmanan
- Bioanalytical Department, QPS Bioserve India Pvt. Ltd, Balanagar, Hyderabad-, 500 037, India
| | - Shiva Prasad Vvs
- Bioanalytical Department, QPS Bioserve India Pvt. Ltd, Balanagar, Hyderabad-, 500 037, India
| | - Srinibas Patro Gudla
- Bioanalytical Department, QPS Bioserve India Pvt. Ltd, Balanagar, Hyderabad-, 500 037, India
| | - Rosaiah Prudhivi
- Bioanalytical Department, QPS Bioserve India Pvt. Ltd, Balanagar, Hyderabad-, 500 037, India
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Hu X, Zheng Y, Wu G, Liu J, Chen J, Huang M, Zhou H, Wu L, Shen-Tu J. An Economical Online Solid-Phase Extraction LC-MS/MS Method for Quantifying Methylprednisolone. J Chromatogr Sci 2014; 53:1013-9. [PMID: 25404561 DOI: 10.1093/chromsci/bmu144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Indexed: 11/14/2022]
Abstract
An economical, reproducible and automated online solid-phase extraction coupled with liquid chromatography-tandem mass spectrometry method was developed to quantify methylprednisolone in human plasma. The method was validated in terms of selectivity, precision/accuracy, process efficiency, stability, cartridge reproducibility and carryover studies. Sample pretreatment was performed by protein precipitation and elimination using methanol followed by water dilution. Then, the mixture was passed onto the HySphere C8 EC-SE online solid-phase extraction cartridge followed by the separation of the analytes on an Agilent Eclipse XDB column. Electrospray ionization in positive ion mode and multiple reaction monitoring were used to monitor the ion transitions at m/z 375.4/160.8 for methylprednisolone, and m/z 361.2/147.0 for prednisolone. The calibration curve ranged from 5.25 to 525 ng/mL. Meanwhile both the intra-day and inter-day precision values (relative standard deviation) were within 4.45%. The method which turns out to be less laborious, faster and lower consumable cost per sample has already been successfully applied to a pharmacokinetic study in which the oral administration of 16 mg methylprednisolone was conducted in Chinese volunteers.
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Affiliation(s)
- Xingjiang Hu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Yunliang Zheng
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Guolan Wu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Jian Liu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Junchun Chen
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Mingzhu Huang
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Huili Zhou
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Lihua Wu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
| | - Jianzhong Shen-Tu
- Research Center for Clinical Pharmacy, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University, Hangzhou 310003, PR China
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Brandão Neto RA, de Carvalho JF. Diagnosis and classification of Addison's disease (autoimmune adrenalitis). Autoimmun Rev 2014; 13:408-11. [PMID: 24424183 DOI: 10.1016/j.autrev.2014.01.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
Abstract
Autoimmune adrenalitis, or autoimmune Addison disease (AAD), is the most prevalent cause of primary adrenal insufficiency in the developed world. AAD is rare and can easily be misdiagnosed as other conditions. The diagnosis depends on demonstrating inappropriately low cortisol production and the presence of high titers of adrenal cortex autoantibodies (ACAs), along with excluding other causes of adrenal failure using other tests as necessary. The treatment corticosteroid replacement, and the prognosis following the treatment is the same as the normal population. Spontaneous recovery of adrenal function has been described but is rare.
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Affiliation(s)
- Rodrigo Antonio Brandão Neto
- Emergency Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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33
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Szeitz A, Manji J, Riggs KW, Thamboo A, Javer AR. Validated assay for the simultaneous determination of cortisol and budesonide in human plasma using ultra high performance liquid chromatography-tandem mass spectrometry. J Pharm Biomed Anal 2013; 90:198-206. [PMID: 24389462 DOI: 10.1016/j.jpba.2013.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/02/2013] [Accepted: 12/05/2013] [Indexed: 11/16/2022]
Abstract
An ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC/MS/MS) method was developed and validated for the quantification of cortisol and budesonide in human plasma. Charcoal stripped human plasma was used as the blank matrix during validation. Cortisol, budesonide, and dexamethasone (internal standard) were extracted from human plasma with methyl-tert-butyl ether, and the chromatographic separation of the peaks was achieved using a Waters Acquity UPLC BEH C18, 1.7 μm, 2.1 mm × 50 mm column with a run time of 4.0 min. Cortisol, budesonide, and dexamethasone were monitored at the total ion current of their respective multiple reaction monitoring transition signals. The UHPLC/MS/MS system consisted of an Agilent 1290 Infinity ultra high performance liquid chromatograph coupled with an AB Sciex Qtrap(®) 5500 hybrid linear ion-trap triple quadrupole mass spectrometer. The method was validated for accuracy, precision, linearity, range, selectivity, lower limit of quantification (LLOQ), recovery, matrix effect, dilution integrity, and evaluation of carry-over. All validation parameters met the acceptance criteria according to regulatory guidelines. The LLOQ was 1.0 ng/mL for both compounds requiring 100 μL of sample. To our knowledge, this is the first validated LC/MS/MS method for the simultaneous quantitative analysis of cortisol and budesonide in human plasma. The method was applied successfully in a clinical investigation of the impact of nasally administered Pulmicort (budesonide) on the hypothalamic-pituitary-adrenal axis of patients with chronic rhinosinusitis.
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Affiliation(s)
- András Szeitz
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
| | - Jamil Manji
- St. Paul's Sinus Centre, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - K Wayne Riggs
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Andrew Thamboo
- St. Paul's Sinus Centre, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Amin R Javer
- St. Paul's Sinus Centre, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
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Matabosch X, Pozo OJ, Monfort N, Pérez-Mañá C, Farré M, Marcos J, Segura J, Ventura R. Urinary profile of methylprednisolone and its metabolites after oral and topical administrations. J Steroid Biochem Mol Biol 2013; 138:214-21. [PMID: 23792784 DOI: 10.1016/j.jsbmb.2013.05.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/30/2013] [Accepted: 05/31/2013] [Indexed: 11/30/2022]
Abstract
Methylprednisolone (MP) is prohibited in sports competitions when administered by systemic routes; however its use by topical administration is allowed. Therefore, analytical approaches to distinguish between these different administration pathways are required. A reporting level of 30ng/mL was established for this purpose. However, the suitability of that reporting level for MP is not known. In the present work, excretion profiles of MP and different metabolites after oral and topical administrations have been compared. A method for the quantification of MP and the qualitative detection of fifteen previously reported metabolites has been validated. The method involved an enzymatic hydrolysis, liquid-liquid extraction and analysis by liquid chromatography coupled to tandem mass spectrometry. The method was found to be linear, selective, precise and accurate. The high sensitivity (limit of detection 0.1ng/mL) and linear range (0.1-250ng/mL) achieved allowed for the quantification of MP at both the low concentrations present after topical administration and the high concentrations detected after oral intake. The method was applied to samples collected after oral (4 or 40mg) and topical administration (10mg of MP aceponate/day for 5 consecutive days) to healthy volunteers. After oral administration, MP and all metabolites were detected in urines collected up to at least 36h. Only MP and five metabolites were detected in samples obtained after topical treatment. As expected, concentrations of MP after topical administration were well below current reporting level (30ng/mL), however 3 out of 4 samples in range 8-24h after the low oral dose (4mg) were also below that concentration. Taking into account metabolites detected after both administration routes, metabolites 16β,17α,21-trihydroxy-6α-methylpregna-1,4-diene-3,11,20-trione (M8) and 17α,20α,21-trihydroxy-6α-methylpregna-1,4-diene-3,11-dione (M11) are best markers to differentiate between topical and oral administrations. Their signals after topical administration were lower than those obtained in the first 48h after all oral doses.
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Affiliation(s)
- Xavier Matabosch
- Bioanalysis Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Doctor Aiguader 88, 08003 Barcelona, Spain.
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Li W, Okwuwa I, Toledo-Frazzini K, Alhomosh A. Adrenal crisis in a patient with acute myeloid leukaemia. BMJ Case Rep 2013; 2013:bcr-2013-010426. [PMID: 23843412 DOI: 10.1136/bcr-2013-010426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Adrenal crisis is a group of clinical manifestation predominantly with hypotensive shock, electrolyte imbalance in a patient with adrenal insufficiency or in a patient who was abruptly withdrawn from glucocorticoid treatment acute myeloid leukaemia (AML) is one of the most common acute leukaemia in adults. Though the above diseases are commonly seen in individual patients, the coexistence of both conditions in the same patient is rare. We reported a 64-year-old African-American man with a history of bilateral deep vein thrombosis, who presented initially with fatigue, neutropenia and macrocytic anaemia. The patient developed a small bowel obstruction during his first hospital course, which resolved spontaneously with conservative management after an exploratory laparotomy. While waiting for his bone marrow biopsy, the patient developed hypotension, hyponatraemia and hyperkalaemia for which adrenal crisis was suspected. Later on, laboratory studies confirmed the diagnosis of primary adrenal insufficiency and the bone marrow was conclusive for AML.
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Affiliation(s)
- Wang Li
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA.
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Monaghan PJ, Keevil BG, Trainer PJ. The use of mass spectrometry to improve the diagnosis and the management of the HPA axis. Rev Endocr Metab Disord 2013; 14:143-57. [PMID: 23494459 DOI: 10.1007/s11154-013-9240-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) is becoming a standard analytical tool in the clinical laboratory for the measurement of small molecules, including steroid hormones. Endocrinologists are coming to acknowledge the superior quality of measurement that is achievable by LC-MS/MS through the enhanced analytical specificity and high sensitivity that this technique offers over conventional immunoassay (IA) methodologies. Additionally, LC-MS/MS overcomes many of the problems encountered in immunoassays, such as anti-reagent antibody interferences and cross-reactivity with structurally related compounds. The potential benefits of applying LC-MS/MS for the assessment of the hypothalamic-pituitary-adrenal (HPA) axis are beginning to be realised. This review critically evaluates recent developments in the application of LC-MS/MS for measurement of glucocorticoids and mineralocorticoids towards the diagnosis and management of HPA axis disorders and aims to address the current unmet need in this expanding field of endocrinology for which future studies into the potential applications of LC-MS/MS should be directed.
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Affiliation(s)
- Phillip J Monaghan
- Department of Clinical Biochemistry, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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Haneef J, Shaharyar M, Husain A, Rashid M, Mishra R, Parveen S, Ahmed N, Pal M, Kumar D. Application of LC-MS/MS for quantitative analysis of glucocorticoids and stimulants in biological fluids. J Pharm Anal 2013; 3:341-348. [PMID: 29403837 PMCID: PMC5760999 DOI: 10.1016/j.jpha.2013.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 03/23/2013] [Indexed: 01/25/2023] Open
Abstract
Liquid chromatography tandem mass chromatography (LC-MS/MS) is an important hyphenated technique for quantitative analysis of drugs in biological fluids. Because of high sensitivity and selectivity, LC-MS/MS has been used for pharmacokinetic studies, metabolites identification in the plasma and urine. This manuscript gives comprehensive analytical review, focusing on chromatographic separation approaches (column packing materials, column length and mobile phase) as well as different acquisition modes (SIM, MRM) for quantitative analysis of glucocorticoids and stimulants. This review is not meant to be exhaustive but rather to provide a general overview for detection and confirmation of target drugs using LC-MS/MS and thus useful in the doping analysis, toxicological studies as well as in pharmaceutical analysis.
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Affiliation(s)
- Jamshed Haneef
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Mohammad Shaharyar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Asif Husain
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Mohd Rashid
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Ravinesh Mishra
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Shama Parveen
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Niyaz Ahmed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India
| | - Manoj Pal
- Department of Chemistry, Indian Institute of Technology (IIT), Haridwar, Roorkee 247667, Uttarakhand, India
| | - Deepak Kumar
- Research Institute of Natural Sciences, Department of Chemistry, Changwon National University, Changwon 641773, Republic of Korea
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Qin H, Yu S, Hu X, Yang Y. Surfactant-Based Ultrasound-Assisted Dispersive Liquid-Liquid Microextraction Determination of Corticosteroids Followed by HPLC-DAD. ANAL LETT 2013. [DOI: 10.1080/00032719.2012.729241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pressurised liquid extraction and ultra-high performance liquid chromatography-tandem mass spectrometry to determine endogenous and synthetic glucocorticoids in sewage sludge. Talanta 2013. [DOI: 10.1016/j.talanta.2012.10.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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40
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McKenzie R, Liley B, Johnston P, Scragg R, Stewart A, Reeder AI, Allen MW. Small doses from artificial UV sources elucidate the photo-production of vitamin D. Photochem Photobiol Sci 2013; 12:1726-37. [DOI: 10.1039/c3pp50041a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Mass spectrometry methods have the potential to measure different hormones during the same analysis and have improved specificity and a wide analytical range compared with many immunoassay methods. Increasingly in clinical laboratories liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays are replacing immunoassays for the routine measurement of testosterone, 17-hydroxyprogesterone, and other steroid hormones. Reference LC-MS/MS methods for steroid, thyroid, and peptide hormones are being used for assessment of the performance and calibration of commercial immunoassays. In this chapter, the general principles of tandem mass spectrometry and examples of hormone assays are described.
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Affiliation(s)
- Helen P Field
- Department of Specialist Laboratory Medicine, St. James's University Hospital, Leeds, UK
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42
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Ribot M, Polito A, Grassin-Delyle S, Annane D, Alvarez JC. Human plasma quantification of fludrocortisone using liquid chromatography coupled with atmospheric pressure chemical ionization mass spectrometry after low-dosage administration. Clin Chim Acta 2012; 420:109-13. [PMID: 23228845 DOI: 10.1016/j.cca.2012.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fludrocortisone acetate is given at very low dosage (50 μg) to patients suffering from septic shock with controversial clinical results. However, it is not clear if absorption is effective in these patients. METHODS An analytical method based upon liquid chromatography coupled to triple quadrupole spectrometry detection with atmospheric pressure chemical ionization interface has been developed for the identification and quantification of fludrocortisone, the active molecule circulating in human plasma. A solid phase extraction of plasma was used after addition of fludrocortisone-D2 as internal standard. Compounds were separated on a C18 column with a gradient of methanol-formate buffer. The ion transitions used to monitor analytes were m/z 381→239 and m/z 381→181 for fludrocortisone and m/z 383→239 and m/z 383→181 for fludrocortisone-D2. RESULTS Retention times were 4.0 min for both compounds. Calibration curves were linear for fludrocortisone in the 0.1-25 ng/ml range. The limits of detection and quantification were 0.05 ng/ml and 0.1 ng/ml, respectively. The intra- and inter-assay precisions were lower than 10.9% and the recovery was 101.8%. A slight matrix effect by about 10% was observed. Application of the method to a patient in septic shock treated with one 50-μg dose of fludrocortisone acetate has shown a maximal plasma concentration of 0.36 ng/ml obtained after 2h. CONCLUSION This method allows fludrocortisone pharmacokinetic/pharmacodynamic studies when given at low dosage in an intensive care unit in case of adrenal insufficiency during a septic shock.
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Affiliation(s)
- Mégane Ribot
- Laboratoire de Pharmacologie-Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, 92380 Garches et Université Versailles Saint-Quentin, France
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Simultaneous determination of montelukast as sparing therapy with some inhaled corticosteroids in plasma of asthmatic patients. J Pharm Biomed Anal 2012; 74:250-6. [PMID: 23245258 DOI: 10.1016/j.jpba.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/02/2012] [Accepted: 11/03/2012] [Indexed: 11/20/2022]
Abstract
Montelukast (MKST) is a leukotriene receptor antagonist that has been concomitantly used with inhaled corticosteroids (ICS) for its steroid-sparing effect in the long-term management of asthma. However, the simultaneous determination of MKST, when used as ICS tapering therapy, with ICS in human plasma has not yet been reported. A fast and efficient reversed phase monolith HPLC method was developed for simultaneous determination of MKST with some ICS in plasma of asthmatic patients. The separation was achieved on monolith reversed phase column by isocratic mode at a flow rate of 1.0 ml min(-1) using a mobile phase consisted of a mixture of acetonitrile and 10mM phosphate buffer adjusted to pH 3.5 (40:60, v/v) and detected at 240 nm. Betamethasone dipropionate (BDP) was used as the internal standard. All the studied ICS and MKST were efficiently separated within less than 6 min. The obtained linearity range for the developed HPLC method was 0.03-10 μg ml(-1) with correlation coefficients>0.9995 and the detection limits were 0.009-0.016 μg ml(-1) in plasma for all the studied drugs. The method was validated in agreement with the requirements of US-FDA guideline and was recommended for the target applications. The method is valuable for investigations concerned with the effective tapering of ICS therapy with MKST in patients with chronic asthma in clinical practice without loss of asthma control.
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Seo JH, Park JS, Jo MH, Park MS, Ryu JH, Cho YW, Shim WS, Noh GJ, Lee KT. Rapid and sensitive LC-MS/MS method for determination of megestrol acetate in human plasma: application to a human pharmacokinetic study. Biomed Chromatogr 2012; 27:409-15. [DOI: 10.1002/bmc.2807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/06/2022]
Affiliation(s)
| | - Ji-Sun Park
- Kyung Hee Drug Analysis Center; 1 Hoegi-Dong Dongdaemun-gu; Seoul; 130-701; Republic of Korea
| | | | | | | | - Young-Wuk Cho
- Department of Biomedical Science, College of Medical Science; Kyung Hee University; 1 Hoegi-Dong Dongdaemun-gu; Seoul; 130-701; Republic of Korea
| | - Wang-Sup Shim
- Kyung Hee Drug Analysis Center; 1 Hoegi-Dong Dongdaemun-gu; Seoul; 130-701; Republic of Korea
| | - Gyu-Jeong Noh
- Department of Clinical Pharmacology and Therapeutics and Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; 388-1 Pungnap 2-dong, Songpa-gu; Seoul; 138-736; Republic of Korea
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Clinical Pharmacokinetics and Pharmacodynamics of Prednisolone and Prednisone in Solid Organ Transplantation. Clin Pharmacokinet 2012; 51:711-41. [DOI: 10.1007/s40262-012-0007-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Kovacs K, Wagley S, Quirk MT, Ceron OM, Silva PA, Singh RJ, Gukasyan HJ, Arroyo JG. Pharmacokinetic study of vitreous and serum concentrations of triamcinolone acetonide after posterior sub-tenon's injection. Am J Ophthalmol 2012; 153:939-48. [PMID: 22310078 DOI: 10.1016/j.ajo.2011.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/18/2011] [Accepted: 10/19/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To compare a theoretical pharmacokinetic model of triamcinolone acetonide after posterior sub-Tenon's injection with experimental serum and undiluted vitreous triamcinolone acetonide concentrations obtained during pars plana vitrectomy. DESIGN Clinical-practice, prospective, interventional case series study. METHODS This study compared computer-modeled triamcinolone acetonide diffusion after posterior sub-Tenon's injection with triamcinolone acetonide levels in experimental undiluted vitreous and serum samples from 57 patients undergoing vitrectomy assessed via mass spectrometry and high-pressure liquid chromatography. At least 5 pairs of samples were collected at each of 7 time points (1 day, 3 days, and 1, 2, 3, 4, and 8 weeks) after triamcinolone acetonide injection, with 6 controls without injection. Cortisol levels were measured in 31 sets of samples. RESULTS The theoretical model predicted that triamcinolone acetonide levels in systemic blood, vitreous, and choroidal extracellular matrix would plateau after 3 days at 15 ng/mL, 227 ng/mL and 2230 ng/mL, respectively. Experimental vitreous levels of triamcinolone peaked at 111 ng/mL at day 1, then reached a plateau in the range 15 to 25 ng/mL, while serum triamcinolone levels peaked at day 3 near 35 ng/mL and plateaued near 2 to 8 ng/mL. Serum triamcinolone and cortisol levels were inversely correlated (Spearman -0.42, P = .02). CONCLUSIONS The theoretical model predicts efficient delivery of triamcinolone acetonide from the posterior sub-Tenon's space to the extracellular choroidal matrix. The experimental findings demonstrate low levels of serum triamcinolone that alter systemic cortisol levels and higher vitreous levels lasting at least 1 month. Both assessments support trans-scleral delivery of posterior sub-Tenon's triamcinolone.
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Herrero P, Borrull F, Pocurull E, Marcé R. Determination of glucocorticoids in sewage and river waters by ultra-high performance liquid chromatography–tandem mass spectrometry. J Chromatogr A 2012; 1224:19-26. [DOI: 10.1016/j.chroma.2011.12.054] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/15/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
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Hempen C, Elfering S, Mulder AHL, van den Bergh FAJTM, Maatman RGHJ. Dexamethasone suppression test: development of a method for simultaneous determination of cortisol and dexamethasone in human plasma by liquid chromatography/tandem mass spectrometry. Ann Clin Biochem 2012; 49:170-6. [PMID: 22247524 DOI: 10.1258/acb.2011.011004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dexamethasone is a synthetic glucocorticoid and is analogous to cortisol. It is used in the low-dose overnight dexamethasone suppression test (LDODST) to diagnose hypercortisolism in patients suspected to be suffering from Cushing's syndrome (CS). Measuring plasma dexamethasone in conjunction with measuring the amount of cortisol following the LDODST may allow clinicians to improve the diagnosis of CS. METHODS Plasma samples were cleaned up by solid-phase extraction before analysis. Liquid chromatographic separation was carried out under reversed-phase conditions prior to detection by tandem mass spectrometry. The analytes were determined in the presence of deuterated internal standards cortisol-d4 and dexamethasone-d4. RESULTS Limit of quantitation (LOQ) was 1.89 nmol/L for dexamethasone and <0.02 μmol/L for cortisol. Recoveries of both analytes ranged from 80.2% to 114.4%. Intra- and interassay coefficients of variation were <15%. The concentration of dexamethasone and cortisol was determined in 62 patients after performing LDODST. Dexamethasone concentrations ranged from 3.0 to 21.5 nmol/L (median 7.4 nmol/L) for 57 of these samples. For five patients the concentration was <LOQ. Cortisol concentrations were <0.08 μmol/L (median 0.037 μmol/L, n = 54) except for eight patients (>0.22 μmol/L). CONCLUSIONS A method for the simultaneous measurement of dexamethasone and cortisol in human plasma by liquid chromatography/tandem mass spectrometry has been developed and validated. The method is suitable for controlling the compliance to the LDODST and for determining the cortisol plasma concentration after the test. The interpretation of LDODSTs was improved by the simultaneous determination of both analytes.
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Affiliation(s)
- C Hempen
- Medisch Spectrum Twente Laboratory, PO Box 50000, 7500 KA, Enschede, The Netherlands.
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Buscher B, Jägfeldt H, Sandman H, Brust-van Schaik R, van Schaik F, Brüll L. The determination of budesonide and fluticasone in human sputum samples collected from COPD patients using LC–MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 880:6-11. [DOI: 10.1016/j.jchromb.2011.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/21/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
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Djedovic NK, Rainbow SJ. Detection of synthetic glucocorticoids by liquid chromatography-tandem mass spectrometry in patients being investigated for Cushing's syndrome. Ann Clin Biochem 2011; 48:542-9. [PMID: 21846739 DOI: 10.1258/acb.2011.010250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background We report a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the detection of four commonly prescribed steroid drugs (prednisolone, dexamethasone, betamethasone and beclomethasone dipropionate) while simultaneously measuring 24-h urine free cortisol and cortisone in patients. Methods Two hundred and fifty microlitre aliquots of urine were spiked with internal standard and extracted with dichloromethane. The MS instrument was operated with positive electrospray and multiple reaction monitoring. Two transitions were monitored for each analyte of interest and the ratio of the intensities of the product ion fragments was established. Results The LC-MS/MS method for the measurement of urine free cortisol and cortisone was established. The assay was linear up to 788 nmol/L for cortisol and 777 nmol/L for cortisone, with a limit of quantitation of 5.0 nmol/L for both. Analysis time per sample was seven minutes. Transitions for four synthetic glucocorticoids were included, and they were identified based on the ratio of the intensities of product ion fragments. Analysis of 219 samples collected from 154 patients (55 male and 99 female) revealed the presence of prednisolone in five samples from three patients. Dexamethasone was detected in samples from four patients, and betamethasone was detected in one sample. Conclusion This is the first LC-MS/MS method in routine use to combine quantification of urinary cortisol and cortisone and detection of synthetic glucocorticoids in patients being investigated for Cushing's syndrome. Since the most common quoted cause of Cushing's syndrome is steroid treatment, this is a valuable diagnostic tool.
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Affiliation(s)
- N K Djedovic
- Department of Clinical Biochemistry, Northwick Park Hospital, North West London Hospitals NHS Trust, Harrow, Middlesex HA1 3UJ, UK
| | - S J Rainbow
- Department of Clinical Biochemistry, Northwick Park Hospital, North West London Hospitals NHS Trust, Harrow, Middlesex HA1 3UJ, UK
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