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Liu F, Hutchinson R. Visible particles in parenteral drug products: A review of current safety assessment practice. Curr Res Toxicol 2024; 7:100175. [PMID: 38975062 PMCID: PMC11223083 DOI: 10.1016/j.crtox.2024.100175] [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: 03/29/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Parenteral drug products (PDPs) are administered extensively to treat various diseases. Product quality plays a critical role in ensuring patient safety and product efficacy. One important quality challenge is the contamination of particles in PDPs. Particle presence in PDPs represents potential safety risk to patients. Differential guidance and practice have been in place for visible (VPs) and subvisible particles (SVPs) in PDPs. For SVPs, the amount limits have been harmonized in multiple Pharmacopeias. The pharmaceutical industry follows the guided limits for regulatory and quality compliance. However, for VPs, no such acceptable limit has been set. This results in not only quality but also safety challenges for manufacturers and drug developers in managing and evaluating VPs. It is important to understand the potential safety risk of VPs so these can be weighed against the benefit of the PDPs. To evaluate their potential risk(s), it is necessary to understand their nature, origin, frequency of their occurrence, safety risk, the risk mitigation measures, and the method to evaluate their safety. The current paper reviews the critical literature on these aspects and provides insight into considerations when performing safety assessment and managing the risk(s) for VPs in PDPs.
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Affiliation(s)
- Frank Liu
- Safe Product Services LLC, Pittsfield, MA, USA
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2
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Mule D, Chaturvedi S, Badgujar D, Paritala ST, Sharma N, Shah RP. Drug-Leachable Interaction Product Evaluation in Prefilled Syringe of Ganirelix Acetate Injection. J Pharm Sci 2024:S0022-3549(24)00183-7. [PMID: 38796153 DOI: 10.1016/j.xphs.2024.05.012] [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: 01/13/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
The concept of extractables and leachable has introduced a new era for identifying potential impurities in drug products. Pharmaceutical packaging materials encompass a variety of polymers due to their appealing properties for storing the drug product. However, numerous chemical species may leach into the drug product from these polymers, posing significant health hazards in the public domain. Identifying such leachable is crucial for assessing safety and addressing toxicological concerns. Acrylic acids are commonly used materials for adhering needles to the barrel in pre-filled syringes. In this study, we identified acrylic acid leachable impurities in ganirelix drug products available in the market using mass spectrometry as an analytical technique. These impurities leached into the drug product during storage conditions. Characterization of the impurities was carried out through data obtained from HRMS and MS/MS analysis, revealing them as polyacrylic acid-ganirelix adduct impurities. This study offers valuable insights into identifying leachable and susceptible sites, providing a foundation for potential modifications in similar classes of drug products, thereby enhancing their safety and efficacy.
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Affiliation(s)
- Dinesh Mule
- Department of Pharmaceutical Analysis, The National Institute of Pharmaceutical Education and Research-Ahmedabad (Ministry of Chemicals and Fertilizers, Government of India), Opposite Air force Station, Palaj, Gandhinagar, Gujarat 382355, India
| | - Sachin Chaturvedi
- Department of Pharmaceutical Analysis, The National Institute of Pharmaceutical Education and Research-Ahmedabad (Ministry of Chemicals and Fertilizers, Government of India), Opposite Air force Station, Palaj, Gandhinagar, Gujarat 382355, India
| | - Devendra Badgujar
- Department of Pharmaceutical Analysis, The National Institute of Pharmaceutical Education and Research-Ahmedabad (Ministry of Chemicals and Fertilizers, Government of India), Opposite Air force Station, Palaj, Gandhinagar, Gujarat 382355, India
| | - Sree Teja Paritala
- Department of Pharmaceutical Analysis, The National Institute of Pharmaceutical Education and Research-Ahmedabad (Ministry of Chemicals and Fertilizers, Government of India), Opposite Air force Station, Palaj, Gandhinagar, Gujarat 382355, India
| | - Nitish Sharma
- Department of Pharmaceutical Analysis, The National Institute of Pharmaceutical Education and Research-Ahmedabad (Ministry of Chemicals and Fertilizers, Government of India), Opposite Air force Station, Palaj, Gandhinagar, Gujarat 382355, India.
| | - Ravi P Shah
- Department of Pharmaceutical Analysis, The National Institute of Pharmaceutical Education and Research-Ahmedabad (Ministry of Chemicals and Fertilizers, Government of India), Opposite Air force Station, Palaj, Gandhinagar, Gujarat 382355, India.
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3
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Arroyo A, Booij P, Woldemariam G, Bruen U, Creasey J, Stanard B, Parris P, Nagao L, Bielinski MK. Cell and Gene Therapies: Challenges in Designing Extractables and Leachables Studies and Conducting Safety Assessments. J Pharm Sci 2024; 113:513-522. [PMID: 38176455 DOI: 10.1016/j.xphs.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
Over the past decade, Cell and Gene Therapies (C>) have been an emerging therapeutic area with more than twenty C> drug products approved and over 1000 registered trials. The remarkable progress in these modalities brings new challenges for scientists who evaluate manufacturing and storage materials, including risk assessments for extractables and leachables (E&L). Establishing a business process to qualify materials for these applications is an important risk mitigation strategy in support of these assessments. Process validation verifying process performance and product quality requirements using qualified materials also ensures that leachables from the materials do not result in an impact to process and product. The authors provide an overview of available guidelines and publications relevant to E&L risk assessments that can be used to support ex vivo C> products, highlighting gaps and standardization needs in the areas of biocompatibility and extractables conditions. Finally, the authors present leachable testing strategies, relevant to the specific manufacturing and storage conditions of C> products, and safety assessment considerations for organic and inorganic chemical entities.
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Affiliation(s)
- Adeyma Arroyo
- Genentech, Inc., a member of the Roche Group, South San Francisco, CA 94080, USA
| | | | | | - Uma Bruen
- Organon, LLC., Jersey City, NJ 07302, USA
| | | | - Brad Stanard
- Ultragenyx Pharmaceutical Inc., Novato, CA 94949, USA
| | - Patricia Parris
- Pfizer Worldwide Research, Development and Medical, Kent, UK
| | - Lee Nagao
- Faegre Drinker Biddle & Reath LLP, Washington, DC, 20005, USA
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4
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Li M, Zhao X, Yu C, Wang L. Antibody-Drug Conjugate Overview: a State-of-the-art Manufacturing Process and Control Strategy. Pharm Res 2024; 41:419-440. [PMID: 38366236 DOI: 10.1007/s11095-023-03649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024]
Abstract
Antibody-drug conjugates (ADCs) comprise an antibody, linker, and drug, which direct their highly potent small molecule drugs to target tumor cells via specific binding between the antibody and surface antigens. The antibody, linker, and drug should be properly designed or selected to achieve the desired efficacy while minimizing off-target toxicity. With a unique and complex structure, there is inherent heterogeneity introduced by product-related variations and the manufacturing process. Here this review primarily covers recent key advances in ADC history, clinical development status, molecule design, manufacturing processes, and quality control. The manufacturing process, especially the conjugation process, should be carefully developed, characterized, validated, and controlled throughout its lifecycle. Quality control is another key element to ensure product quality and patient safety. A patient-centric strategy has been well recognized and adopted by the pharmaceutical industry for therapeutic proteins, and has been successfully implemented for ADCs as well, to ensure that ADC products maintain their quality until the end of their shelf life. Deep product understanding and process knowledge defines attribute testing strategies (ATS). Quality by design (QbD) is a powerful approach for process and product development, and for defining an overall control strategy. Finally, we summarize the current challenges on ADC development and provide some perspectives that may help to give related directions and trigger more cross-functional research to surmount those challenges.
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Affiliation(s)
- Meng Li
- NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, NMPA Key Laboratory for Quality Research and Evaluation of Biological Products, National Institutes for Food and Drug Control, Beijing, People's Republic of China
| | - Xueyu Zhao
- The Engineering Research Center of Synthetic Polypeptide Drug Discovery and Evaluation of Jiangsu Province, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Chuanfei Yu
- NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, NMPA Key Laboratory for Quality Research and Evaluation of Biological Products, National Institutes for Food and Drug Control, Beijing, People's Republic of China
| | - Lan Wang
- NHC Key Laboratory of Research on Quality and Standardization of Biotech Products, NMPA Key Laboratory for Quality Research and Evaluation of Biological Products, National Institutes for Food and Drug Control, Beijing, People's Republic of China.
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5
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Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Risdiana N. An analysis of the effect of syringe barrel volume on performance and user perception. Medicine (Baltimore) 2023; 102:e33983. [PMID: 37335669 DOI: 10.1097/md.0000000000033983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
In the market, there are many types and shapes of syringes. One of the groupings of syringe types is based on barrel volume. The shape of the product design affects performance and user perception. The aim of this study is to investigate the effect of barrel volume on its performance and user perception. We performed analysis following international organization for standardization 7886 procedures on syringe with 1 mL, 3 mL, 5 mL, and 10 mL volume. In addition, a user perception test was conducted on 29 respondents using a questionnaire with the Likert chart method. This study indicates that the bigger the syringe volume, the larger the dead space and the force to operate the piston are. A larger syringe volume also raises the volume that changes due to the plunger position increase. Meanwhile, the barrel volume does not affect water and water leakage, as we did not observe any leak during the syringe tests in our experiment. In addition, the user perception test shows that the barrel's length influences the ease of device control during the injection. The volume of the barrel negatively correlated with its effect to the environment. The safety features of all syringes are similar except for the 3 mL syringe, which has a value of 0.1 points difference to other syringes.
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Affiliation(s)
| | - M Azuddin
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Nurvita Risdiana
- Department of Mental Health Nursing, School of Nursing, Universitas Muhammadiyah Yogyakarta, Daerah Istimewa Yogyakarta, Indonesia
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Krisdiyanto, Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Muflikhun MA, Risdiana N, Afifuddin E. The hypodermic syringe performance based on the ISO 7886-1:2017: A narrative review. Medicine (Baltimore) 2022; 101:e31812. [PMID: 36626504 PMCID: PMC9750608 DOI: 10.1097/md.0000000000031812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A syringe is used to inject fluid or medicine into the patient's soft tissue. The main components of the syringe were the needle, barrel, and plunger. The use of syringes in the medical world is relatively high, and especially since the COVID-19 pandemic, the use of hypodermic syringes increased sharply due to vaccination. The syringe used must be effective and of good quality, so the International Organization for Standardization (ISO) has published test procedures and minimum specifications for hypodermic syringes. The performance of the syringe can be observed from the dead space, force piston operation, water and air leakage, and fitting position of the plunger in the barrel. This review shows that most researchers use the weighing method to measure the dead space, although some use other methods. The researchers found that most of the products met the minimum specifications of the ISO, and that the dimensions and shape of the syringe affected the dead space. Researchers have not examined other performance measures recommended by the ISO. Researchers have focused more on force injection than force piston operation, leakage after injection or back spray than air and water leakage, and reduction the friction of the plunger without considering the fitting position of the plunger in the barrel.
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Affiliation(s)
- Krisdiyanto
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Mechanical Engineering Department, Faculty of Engineering, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | | | - M. Azuddin
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Muhammad Akhsin Muflikhun
- Mechanical and Industrial Engineering Department, Faculty of Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nurvita Risdiana
- Department of Mental Health Nursing, School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Eki Afifuddin
- Mechanical and Industrial Engineering Department, Faculty of Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Gallegos A, Liu J, Ronk M, Qi L, Li K, Semin D, Nashed-Samuel Y. Recommendation of Single Time Point Leachables Testing for Lyophilized Biotechnology Products Stored in Rubber Stoppered Glass Vial Systems. J Pharm Sci 2022; 111:1599-1604. [DOI: 10.1016/j.xphs.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/15/2022]
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8
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Pistacchio A, Baroni F, Cecchini I, Verani R, Stornaiuolo M, Palmese A, Pergola C. Impact of four inorganic impurities – iron, copper, nickel and zinc - on the quality attributes of a Fc-fusion protein upon incubation at different temperatures. Eur J Pharm Sci 2022; 172:106139. [DOI: 10.1016/j.ejps.2022.106139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 11/26/2022]
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9
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Observation and Mitigation of Leachables from Non-Product Contact Materials in Electromechanical Delivery Devices for Biotechnology Products. J Pharm Sci 2021; 110:3794-3802. [PMID: 34390741 DOI: 10.1016/j.xphs.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/22/2022]
Abstract
Battery-powered drug delivery devices are widely used as primary containers for storing and delivering therapeutic protein products to improve patient compliance and quality of life. Compared to conventional delivery approaches such as pre-filled syringes, battery-powered devices are more complex in design requiring new materials/components for proper functionality, which could cause potential product safety and quality concerns from the extractable and leachables (E&L) of the new materials/components. In this study, E&L assessments were performed on a battery-powered delivery device during the development and qualification of the device, where novel compound 2‑hydroxy-2-methylpropiophenone (HMPP) and related compounds were observed in both E&L. The source of the HMPP and related compounds was identified to be the nonproduct contact device batteries, in which HMPP photo-initiator was used as a curing agent in the battery sealant to prevent leakage of the battery electrolytes. Toxicology assessment was performed, which showed the levels of HMPP observed in the device lots were acceptable relative to the permitted daily exposure. A drug product HMPP spike study was also performed, where no product impact was observed. Based on these assessments, an action threshold and specification limits could be established as a control strategy, if needed, to mitigate the potential risks associate with the observed leachables. As a full resolution, seven battery candidates from different suppliers were screened and one new battery was successfully qualified for the delivery devices. Overall, the holistic E&L approach was fully successful in the development and qualification of the battery-powered devices for biotherapeutic products delivery ensuring product quality and patient safety. Non-product contact materials are commonly rated as low or no risk and typically considered as out of scope of E&L activities for delivery systems following industry benchmark and regulatory agency guidance. This case study is novel as it brings into attention the materials that might not normally be in consideration during the development process. It is highly recommended to understand materials in the context of intended use on a case-by-case basis and not to generalize to ensure successful development and qualification.
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10
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Qi L, Liu J, Ronk M, Gallegos A, Fujimori K, Luo Y, Li K, Lee H, Nashed-Samuel Y. A Holistic Approach of Extractables and Leachables Assessment of Rubber Stoppered Glass Vial Systems for Biotechnology Products. J Pharm Sci 2021; 110:3580-3593. [PMID: 34324943 DOI: 10.1016/j.xphs.2021.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
Rubber stoppered glass vial systems are widely used as primary containers for storing and delivering therapeutic protein products to patients. Addressing concerns and regulatory expectations related to the risk to biologic drug product quality and patient safety from rubber stoppered glass vial systems requires implementation of an extractable and leachable evaluation program based on material understanding, risk assessment, literature review, and a comprehensive scientifically sound analytical testing methodology. The extractable and leachable study design consisted of twelve drug products filled in twelve different size glass vials capped with laminated and nonlaminated rubber stoppers made from three different rubber formulations. Design of the model solvents was successful as they had little to no analytical interference and mimicked the formulation conditions and generated representative extractables capable of predicting leachables. The extraction conditions of time and temperature were appropriate as not to degrade the test materials or the extractable compounds, and yet generated significant quantities for identification of the extractable compounds with confidence. The extractables testing results were capable of predicting the leachable profiles of the twelve drug products. In each case, the leachable profile was a subset of the extractable profile. The organic and elemental impurities of the leachable profiles of drug products were the end-to-end verification of the quality of the glass vials, rubber stoppers and drug product lifecycles. Overall, the holistic approach was fully successful in the qualification of different vial systems as primary containers and delivery systems for different biotherapeutic products to ensure product quality and patient safety.
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Affiliation(s)
- Li Qi
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320.
| | - Jian Liu
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320
| | - Michael Ronk
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320
| | - Alejandra Gallegos
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320
| | - Kiyoshi Fujimori
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320
| | - Yanxin Luo
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320
| | - Kim Li
- Environment, Health, Safety and Sustainability, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320
| | - Hans Lee
- Los Angeles Trade-Technical College, 400 West Washington Blvd, Los Angeles, CA 90015
| | - Yasser Nashed-Samuel
- Attribute Sciences, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320.
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Marschall C, Witt M, Hauptmeier B, Friess W. Powder suspensions in non-aqueous vehicles for delivery of therapeutic proteins. Eur J Pharm Biopharm 2021; 161:37-49. [PMID: 33548460 DOI: 10.1016/j.ejpb.2021.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Abstract
Formulating biopharmaceuticals is a challenging task due to their complex and sensitive nature. Protein drugs are typically marketed either as an aqueous solution or as a lyophilizate. Usually aqueous solutions are preferred as neither drying nor reconstitution are required. But it may be unfeasible if the protein features low stability. An interesting alternative to avoid at least reconstitution are protein powder suspensions in non-aqueous vehicles. Such formulations combine the ready-to-use approach with the high protein stability in the solid state. Additionally, protein powder suspensions offer a potentially lower viscosity compared to aqueous solutions at high protein concentrations. Besides injection, other application routes might also benefit from the protein powder approach such as topical or inhalational delivery. Protein powders, which can be dispersed in the non-aqueous suspension vehicle, are usually prepared by spray-drying or freeze-drying with an additional milling step, but other techniques have also been described in literature. An ideal powder preparation technique results in minimum protein damage and yields particle sizes in the lower micrometre range and homogeneous particle size distribution enabling subcutaneous or intramuscular injection through hypodermic needles. As suspension vehicles traditional non-aqueous injectable liquids, such as plant oils, may be selected. But they show an inherent high viscosity, which can lead to unacceptable glide forces during injection. Furthermore, the vehicle should provide high product stability with respect to protein integrity and suspension resuspendability. This review will describe how proteins can be formulated as protein powder suspensions in non-aqueous vehicles for subcutaneous injection including potential vehicles, protein powder preparation techniques, protein and suspension physical stability, as well as the use in the field of high concentration protein formulations.
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Affiliation(s)
- Christoph Marschall
- Ludwig-Maximilians-Universität München, Department of Pharmacy, Pharmaceutical Technology and Biopharmceutics, Butenandtstraße 5, D-81377 München, Germany; AbbVie Deutschland GmbH, Knollstraße 50, D-67061 Ludwigshafen, Germany(1)
| | - Madlen Witt
- Novaliq GmbH, Im Neuenheimer Feld 515, D-69120 Heidelberg, Germany; Merck KGaA, Frankfurter Straße 250, D-64293 Darmstadt, Germany(1)
| | - Bernhard Hauptmeier
- Novaliq GmbH, Im Neuenheimer Feld 515, D-69120 Heidelberg, Germany; Boehringer Ingelheim, Vetmedica GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany(1)
| | - Wolfgang Friess
- Ludwig-Maximilians-Universität München, Department of Pharmacy, Pharmaceutical Technology and Biopharmceutics, Butenandtstraße 5, D-81377 München, Germany.
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Ingle RG, Fang WJ. Prefilled dual chamber devices (DCDs) - Promising high-quality and convenient drug delivery system. Int J Pharm 2021; 597:120314. [PMID: 33540011 DOI: 10.1016/j.ijpharm.2021.120314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/22/2022]
Abstract
Prefilled dual chamber devices (DCDs) are combination products containing freeze-dried drug and diluent in two separate chambers of the device. DCDs provide high stability and convenience to patients and doctors, thus significantly improving product quality, patient compliance and market competitiveness. DCDs should also provide seal integrity, sterility and compatibility with biopharmaceuticals and avoid leachability and needle stick injuries. DCDs are promising alternatives to traditional containers or devices for biopharmaceuticals. The regulatory and medical practice to choose plastic DCDs as better alternatives over well-established glass syringes will be addressed here. The impact and major issues during processing, manufacturing, and storage of DCDs are also highlighted. Further discussion clears its business potential, composition, stability testing, and quality standard requirements to deal with market competition. It also covers major role of extractables and leachables in storage stability of the product.
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Affiliation(s)
- Rahul G Ingle
- Institute of Drug Metabolism and Pharmaceutical Analysis, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China; Hangzhou Institute of Innovative Medicine, Zhejiang University, Hangzhou 310016, China
| | - Wei-Jie Fang
- Institute of Drug Metabolism and Pharmaceutical Analysis, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China; Hangzhou Institute of Innovative Medicine, Zhejiang University, Hangzhou 310016, China.
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13
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Harper E, Xie Y, Connolly L. Investigating the pre-lethal cytotoxic effects of bis(2,4-di-tert-butylphenyl)phosphate on Chinese hamster ovary cells using high content analysis. J Biotechnol 2021; 328:59-71. [PMID: 33453293 DOI: 10.1016/j.jbiotec.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Abstract
Bis(2,4-di-tert-butylphenyl)Phosphate (bDtBPP) leaches out of polyethylene films used by the biopharmaceutical industry in single-use systems (SUS) for the culturing of drug producing cell lines. Previous studies found bDtBPP (0.025 - 0.110 mg/L) negatively affects Chinese hamster ovary (CHO) cell growth and productivity. Less information is known about the potential early stages of subtle pre-lethal cytotoxic effects of bDtBPP. This study aimed to investigate the pre-lethal cytotoxic effects in CHO-K1 cells of bDtBPP (0.005 - 0.25 μg/ml) at process relevant concentrations following 2, 24 and 48 h exposure, using high content analysis to investigate multiple pre-lethal cytotoxicity markers. After 48 h exposure, bDtBPP (0.005 - 0.25 μg/ml; P ≤ 0.001) increased nuclear intensity. A dose- and time-dependent reduction in mitochondrial mass was seen after exposure to bDtBPP. Reactive oxygen species increased after 2 h exposure to 0.25 μg/ml bDtBPP, 24 and 48 h exposure to 0.05 - 0.25 μg/ml bDtBPP (P ≤ 0.01 and P ≤ 0.001). BDtBPP induced subtle pre-lethal cytotoxic effects on CHO-K1 cellular health. This study highlights the cellular health benefits of the biopharmaceutical industry switching to alternative SUS plastics which do not leach bDtBPP, which may enhance CHO-K1 cell productivity.
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Affiliation(s)
- Emma Harper
- Institute for Global Food Security, School of Biological Sciences, 19 Chlorine Gardens, BT9 5DL, Queen's University Belfast, Northern Ireland, UK
| | - Yuling Xie
- Institute for Global Food Security, School of Biological Sciences, 19 Chlorine Gardens, BT9 5DL, Queen's University Belfast, Northern Ireland, UK
| | - Lisa Connolly
- Institute for Global Food Security, School of Biological Sciences, 19 Chlorine Gardens, BT9 5DL, Queen's University Belfast, Northern Ireland, UK.
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15
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Kelly PS, Dorival‐García N, Paré S, Carillo S, Ta C, Alarcon Miguez A, Coleman O, Harper E, Shannon M, Henry M, Connolly L, Clynes M, Meleady P, Bones J, Barron N. Improvements in single‐use bioreactor film material composition leads to robust and reliable Chinese hamster ovary cell performance. Biotechnol Prog 2019; 35:e2824. [DOI: 10.1002/btpr.2824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Paul S. Kelly
- National Institute for Bioprocessing Research and Training Fosters Avenue, Mount Merrion, Blackrock, Co. Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Noemi Dorival‐García
- National Institute for Bioprocessing Research and Training Fosters Avenue, Mount Merrion, Blackrock, Co. Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Samantha Paré
- National Institute for Cellular BiotechnologyDublin City University Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Sara Carillo
- National Institute for Bioprocessing Research and Training Fosters Avenue, Mount Merrion, Blackrock, Co. Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Christine Ta
- National Institute for Bioprocessing Research and Training Fosters Avenue, Mount Merrion, Blackrock, Co. Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | | | - Orla Coleman
- National Institute for Cellular BiotechnologyDublin City University Dublin Ireland
| | - Emma Harper
- Institute for Global Food SecuritySchool of Biological Sciences, Queen's University Belfast Northern Ireland UK
| | - Maeve Shannon
- Institute for Global Food SecuritySchool of Biological Sciences, Queen's University Belfast Northern Ireland UK
| | - Michael Henry
- National Institute for Cellular BiotechnologyDublin City University Dublin Ireland
| | - Lisa Connolly
- Institute for Global Food SecuritySchool of Biological Sciences, Queen's University Belfast Northern Ireland UK
| | - Martin Clynes
- National Institute for Cellular BiotechnologyDublin City University Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Paula Meleady
- National Institute for Cellular BiotechnologyDublin City University Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Jonathan Bones
- National Institute for Bioprocessing Research and Training Fosters Avenue, Mount Merrion, Blackrock, Co. Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
| | - Niall Barron
- National Institute for Bioprocessing Research and Training Fosters Avenue, Mount Merrion, Blackrock, Co. Dublin Ireland
- School of Chemical and Bioprocess EngineeringUniversity College Dublin Dublin Ireland
- Synthesis and Solid State Pharmaceutical CentreUniversity of Limerick Limerick Ireland
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16
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Williams KL. The Biologics Revolution and Endotoxin Test Concerns. ENDOTOXIN DETECTION AND CONTROL IN PHARMA, LIMULUS, AND MAMMALIAN SYSTEMS 2019. [PMCID: PMC7123716 DOI: 10.1007/978-3-030-17148-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The advent of “at will” production of biologics in lieu of harvesting animal proteins (i.e. insulin) or human cadaver proteins (i.e. growth hormone) has revolutionized the treatment of disease. While the fruits of the biotechnology revolution are widely acknowledged, the realization of the differences in the means of production and changes in the manner of control of potential impurities and contaminants in regard to the new versus the old are less widely appreciated. This chapter is an overview of the biologics revolution in terms of the rigors of manufacturing required to produce them, their mechanism of action, and caveats of endotoxin control. It is a continulation of the previous chapter that established a basic background knowledge of adaptive immune principles necessary to understand the mode of action of both disease causation and biologics therapeutic treatment via immune modulation.
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17
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Scherer N, Marcseková K, Posset T, Winter G. New studies on leachables in commercial scale protein drug filling lines using stir bar sorptive extraction coupled with TD-GC–MS and UPLC/QTOF-MS/MS analytics. Int J Pharm 2019; 555:404-419. [DOI: 10.1016/j.ijpharm.2018.11.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/28/2022]
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18
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Salmean C, Dimartino S. 3D-Printed Stationary Phases with Ordered Morphology: State of the Art and Future Development in Liquid Chromatography. Chromatographia 2018. [DOI: 10.1007/s10337-018-3671-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Identification of leachables observed in the size exclusion chromatograms of a low concentration product stored in prefilled syringes. J Pharm Biomed Anal 2017; 139:133-142. [DOI: 10.1016/j.jpba.2017.02.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 11/23/2022]
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20
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Bodier-Montagutelli E, Respaud R, Watier H, Guillon-Munos A. MAbDelivery: Administration routes for antibody therapy Third LabEx MAbImprove industrial workshop, July 2, 2015 Tours, France. MAbs 2017; 9:579-585. [PMID: 28346048 PMCID: PMC5419087 DOI: 10.1080/19420862.2017.1298899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022] Open
Abstract
The annual "LabEx MAbImprove Industrial Workshops" are primarily intended to provide a comprehensive view about topics of interest for the pharmaceutical industry to scientists involved in research on therapeutic antibodies. The third workshop in this series, held July 2, 2015 in Tours, was dedicated to the optimization of delivery, namely all processes leading monoclonal antibodies to reach their target site. The commonly used intravenous (IV) route, although advantageous in terms of pharmacokinetics and pharmacodynamics, presents some disadvantages in terms of patients' convenience, therapeutic target access or treatment cost. Such problems led pharmaceutical companies to consider more straightforward and patient-friendly administration routes, bringing the need for specific formulations adapted to the specific inherent physicochemical challenges. In this context, the workshop provided an overview of these advances and opened discussion on new administration routes and formulation development. In the first session, the opportunities and challenges of 3 main routes of administration (IV, subcutaneous (SC), and pulmonary) were discussed, integrating protein stability issues. The next session was dedicated to medical devices intended for SC and pulmonary administration. The last session focused on specific formulations for monoclonal antibodies, particularly to successfully protect antibodies upon aerosolization, to develop highly concentrated formulations for SC administration, and to use formulation as a mean to overcome the barriers to oral protein delivery. As in the previous editions, this workshop gathered people from the academic and industrial spheres and allowed rich debates and discussions.
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Affiliation(s)
- Elsa Bodier-Montagutelli
- Université François Rabelais, UMR 1100, Tours, France
- INSERM, Centre d'Etude des Pathologies Respiratoires, UMR, Tours, France
- Service de Pharmacie, CHRU de Tours, Tours, France
| | - Renaud Respaud
- Université François Rabelais, UMR 1100, Tours, France
- INSERM, Centre d'Etude des Pathologies Respiratoires, UMR, Tours, France
- Service de Pharmacie, CHRU de Tours, Tours, France
| | - Hervé Watier
- Université François Rabelais, UMR 1100, Tours, France
- Service d'Immunologie, CHRU de Tours, Tours, France
- CNRS, Génétique, Immunothérapie, Chimie et Cancer, UMR, Tours, France
| | - Audrey Guillon-Munos
- Université François Rabelais, UMR 1100, Tours, France
- Groupe IMT, Tours, France
- Bio Institute, Tours, France
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21
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Saller V, Hediger C, Matilainen J, Grauschopf U, Bechtold-Peters K, Mahler HC, Friess W. Influence of particle shedding from silicone tubing on antibody stability. J Pharm Pharmacol 2016; 70:675-685. [DOI: 10.1111/jphp.12603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/10/2016] [Indexed: 12/28/2022]
Abstract
Abstract
Objectives
Peristaltic pumps are increasingly employed during fill & finish operations of a biopharmaceutical drug, due to sensitivity of many biological products to rotary piston pump-related stresses. Yet, possibly also unit operations using peristaltic pumps may shed particulates into the final product due to abrasion from the employed tubing. It was the aim of this study to elucidate the potential influence of particles shed from peristaltic pump tubing on the stability of a drug product.
Methods
Spiking solutions containing shed silicone particles were prepared via peristaltic pumping of placebo under recirculating conditions and subsequently characterized. Two formulated antibodies were spiked with two realistic, but worst-case levels of particles and a 6-month accelerated stability study with storage at 2–8, 25 and 40°C were conducted.
Key findings
Regarding the formation of aggregates and fragments, both mAbs degraded at their typically expected rates and no additional impact of spiked particles was observed. No changes were discerned however in turbidity, subvisible and visible particle assessments. Flow imaging data for one of the mAb formulations with spiked particles suggested limited colloidal stability of shed particles as indicated by a similar increase in spiked placebo.
Conclusions
Shed silicone particles from peristaltic pump tubing are assumed to not impair drug product stability.
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Affiliation(s)
- Verena Saller
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Constanze Hediger
- F. Hoffmann-La Roche Ltd, Pharmaceutical Development & Supplies, PTD Biologics Europe, Basel, Switzerland
| | - Julia Matilainen
- F. Hoffmann-La Roche Ltd, Pharmaceutical Development & Supplies, PTD Biologics Europe, Basel, Switzerland
| | - Ulla Grauschopf
- F. Hoffmann-La Roche Ltd, Pharmaceutical Development & Supplies, PTD Biologics Europe, Basel, Switzerland
| | - Karoline Bechtold-Peters
- F. Hoffmann-La Roche Ltd, Pharmaceutical Development & Supplies, PTD Biologics Europe, Basel, Switzerland
| | - Hanns-Christian Mahler
- F. Hoffmann-La Roche Ltd, Pharmaceutical Development & Supplies, PTD Biologics Europe, Basel, Switzerland
| | - Wolfgang Friess
- Department of Pharmacy, Pharmaceutical Technology and Biopharmaceutics, Ludwig-Maximilians-Universität München, Munich, Germany
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22
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Kirshner SL. Mechanisms Underlying the Immunogenicity of Therapeutic Proteins: Risk Assessment and Management Strategies. J Interferon Cytokine Res 2014; 34:923-930. [PMID: 25493959 DOI: 10.1089/jir.2013.0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antibodies to therapeutic proteins have caused serious adverse events and loss of efficacy in patients. Therefore, it is critical to manage the risk of antitherapeutic antibodies (ATA) during drug development and in the postmarketing environment. Risk assessments are an important tool for managing immunogenicity risk because they provide a format for considering the consequences and likelihood of ATA development. Because many factors influence both the severity of the consequences and likelihood of ATA development, successful risk assessments require input from all relevant disciplines, including product quality, manufacturing, nonclinical, pharmacology, and clinical. The results of risk assessments are used to develop appropriate risk reduction strategies, which may include product quality and manufacturing controls and elements of clinical trial design. This article discusses considerations for immunogenicity risk assessments and management.
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Affiliation(s)
- Susan L Kirshner
- Division of Therapeutic Proteins, U.S. Food and Drug Administration , Bethesda, Maryland
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23
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Stewart J, Drexler DM, Leet JE, McNaney CA, Herbst JJ. Labware additives identified to be selective monoamine oxidase-B inhibitors. ACTA ACUST UNITED AC 2014; 19:1409-14. [PMID: 25296658 DOI: 10.1177/1087057114551523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Plastic labware is used in all processes of modern pharmaceutical research, including compound storage and biological assays. The use of these plastics has created vast increases in productivity and cost savings as experiments moved from glass test tubes and capillary pipettes to plastic microplates and multichannel liquid handlers. One consequence of the use of plastic labware, however, is the potential release of contaminants and their resultant effects on biological assays. We report herein the identification of biologically active substances released from a commonly used plastic microplate. The active contaminants were identified by gas chromatography-mass spectroscopy as dodecan-1-ol, dodecyl 3-(3-dodecoxy-3-oxopropyl)sulfanylpropanoate, and dodecanoic acid, and they were found to be selective monoamine oxidase-B inhibitors.
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Affiliation(s)
- Jeremy Stewart
- Leads Discovery & Optimization, Research and Development, Bristol-Myers Squibb Co., Wallingford, CT, USA
| | - Dieter M Drexler
- Pharmaceutical Candidate Optimization, Research and Development, Bristol-Myers Squibb Co., Wallingford, CT, USA
| | - John E Leet
- Synthesis & Analytical Technology Team, Research and Development, Bristol-Myers Squibb Co., Wallingford, CT, USA
| | - Colleen A McNaney
- Pharmaceutical Candidate Optimization, Research and Development, Bristol-Myers Squibb Co., Wallingford, CT, USA
| | - John J Herbst
- Leads Discovery & Optimization, Research and Development, Bristol-Myers Squibb Co., Wallingford, CT, USA
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24
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Jenke DR. Extractables and leachables considerations for prefilled syringes. Expert Opin Drug Deliv 2014; 11:1591-600. [DOI: 10.1517/17425247.2014.928281] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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25
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Impact of Residual Impurities and Contaminants on Protein Stability. J Pharm Sci 2014; 103:1315-30. [DOI: 10.1002/jps.23931] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 02/03/2023]
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26
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Pilaniya K, Chandrawanshi HK, Pilaniya U, Manchandani P, Jain P, Singh N. Recent trends in the impurity profile of pharmaceuticals. J Adv Pharm Technol Res 2012; 1:302-10. [PMID: 22247862 PMCID: PMC3255420 DOI: 10.4103/0110-5558.72422] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Various regulatory authorities such as the International Conference on Harmonization (ICH), the United States Food and Drug administration (FDA), and the Canadian Drug and Health Agency (CDHA) are emphasizing on the purity requirements and the identification of impurities in Active Pharmaceutical Ingredients (APIs). The various sources of impurity in pharmaceutical products are — reagents, heavy metals, ligands, catalysts, other materials like filter aids, charcoal, and the like, degraded end products obtained during \ after manufacturing of bulk drugs from hydrolysis, photolytic cleavage, oxidative degradation, decarboxylation, enantiomeric impurity, and so on. The different pharmacopoeias such as the British Pharmacopoeia, United State Pharmacopoeia, and Indian Pharmacopoeia are slowly incorporating limits to allowable levels of impurities present in APIs or formulations. Various methods are used to isolate and characterize impurities in pharmaceuticals, such as, capillary electrophoresis, electron paramagnetic resonance, gas–liquid chromatography, gravimetric analysis, high performance liquid chromatography, solid-phase extraction methods, liquid–liquid extraction method, Ultraviolet Spectrometry, infrared spectroscopy, supercritical fluid extraction column chromatography, mass spectrometry, Nuclear magnetic resonance (NMR) spectroscopy, and RAMAN spectroscopy. Among all hyphenated techniques, the most exploited techniques for impurity profiling of drugs are Liquid Chromatography (LC)-Mass Spectroscopy (MS), LC-NMR, LC-NMR-MS, GC-MS, and LC-MS. This reveals the need and scope of impurity profiling of drugs in pharmaceutical research.
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Affiliation(s)
- Kavita Pilaniya
- Department of Pharmaceutics, Shivdan Singh Institute of Technology and Management, Aligarh, U.P., India
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27
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Wakankar AA, Wang Y, Canova‐Davis E, Ma S, Schmalzing D, Grieco J, Milby T, Reynolds T, Mazzarella K, Hoff E, Gomez S, Martin‐Moe S. On Developing a Process for Conducting Extractable–Leachable Assessment of Components Used for Storage of Biopharmaceuticals. J Pharm Sci 2010; 99:2209-18. [DOI: 10.1002/jps.22012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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28
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Watson J, Greenough EB, Leet JE, Ford MJ, Drexler DM, Belcastro JV, Herbst JJ, Chatterjee M, Banks M. Extraction, identification, and functional characterization of a bioactive substance from automated compound-handling plastic tips. ACTA ACUST UNITED AC 2009; 14:566-72. [PMID: 19470712 DOI: 10.1177/1087057109336594] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Disposable plastic labware is ubiquitous in contemporary pharmaceutical research laboratories. Plastic labware is routinely used for chemical compound storage and during automated liquid-handling processes that support assay development, high-throughput screening, structure-activity determinations, and liability profiling. However, there is little information available in the literature on the contaminants released from plastic labware upon DMSO exposure and their resultant effects on specific biological assays. The authors report here the extraction, by simple DMSO washing, of a biologically active substance from one particular size of disposable plastic tips used in automated compound handling. The active contaminant was identified as erucamide ((Z)-docos-13-enamide), a long-chain mono-unsaturated fatty acid amide commonly used in plastics manufacturing, by gas chromatography/mass spectroscopy analysis of the DMSO-extracted material. Tip extracts prepared in DMSO, as well as a commercially obtained sample of erucamide, were active in a functional bioassay of a known G-protein-coupled fatty acid receptor. A sample of a different disposable tip product from the same vendor did not release detectable erucamide following solvent extraction, and DMSO extracts prepared from this product were inactive in the receptor functional assay. These results demonstrate that solvent-extractable contaminants from some plastic labware used in the contemporary pharmaceutical research and development (R&D) environment can be introduced into physical and biological assays during routine compound management liquid-handling processes. These contaminants may further possess biological activity and are therefore a potential source of assay-specific confounding artifacts.
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Affiliation(s)
- John Watson
- Bristol-Myers Squibb Company, Research and Development, Wallingford, Connecticut 06492, USA.
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