1
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Burt T, Roffel AF, Langer O, Anderson K, DiMasi J. Strategic, feasibility, economic, and cultural aspects of Phase 0 approaches. Clin Transl Sci 2022; 15:1355-1379. [PMID: 35278281 PMCID: PMC9199889 DOI: 10.1111/cts.13269] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 12/05/2022] Open
Abstract
Research conducted over the past 2 decades has enhanced the validity and expanded the applications of microdosing and other phase 0 approaches in drug development. Phase 0 approaches can accelerate drug development timelines and reduce attrition in clinical development by increasing the quality of candidates entering clinical development and by reducing the time to “go‐no‐go” decisions. This can be done by adding clinical trial data (both healthy volunteers and patients) to preclinical candidate selection, and by applying methodological and operational advantages that phase 0 have over traditional approaches. The main feature of phase 0 approaches is the limited, subtherapeutic exposure to the test article. This means a reduced risk to research volunteers, and reduced regulatory requirements, timelines, and costs of first‐in‐human (FIH) testing. Whereas many operational aspects of phase 0 approaches are similar to those of other early phase clinical development programs, they have some unique strategic, regulatory, ethical, feasibility, economic, and cultural aspects. Here, we provide a guidance to these operational aspects and include case studies to highlight their potential impact in a range of clinical development scenarios.
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Affiliation(s)
- Tal Burt
- Phase‐0/Microdosing Network New York NY USA
- Burt Consultancy, LLC. New York NY USA
| | - Ad F. Roffel
- ICON plc, Van Swietenlaan 6, 9728 NZ Groningen The Netherlands
| | - Oliver Langer
- Department of Clinical Pharmacology Medical University of Vienna 1090 Vienna Austria
- Department of Biomedical Imaging and Image‐guided Therapy Medical University of Vienna 1090 Vienna Austria
| | | | - Joseph DiMasi
- Tufts Center for the Study of Drug Development Tufts University Boston MA USA
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2
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van Groen BD, Krekels EHJ, Mooij MG, van Duijn E, Vaes WHJ, Windhorst AD, van Rosmalen J, Hartman SJF, Hendrikse NH, Koch BCP, Allegaert K, Tibboel D, Knibbe CAJ, de Wildt SN. The Oral Bioavailability and Metabolism of Midazolam in Stable Critically Ill Children: A Pharmacokinetic Microtracing Study. Clin Pharmacol Ther 2021; 109:140-149. [PMID: 32403162 PMCID: PMC7818442 DOI: 10.1002/cpt.1890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
Midazolam is metabolized by the developmentally regulated intestinal and hepatic drug-metabolizing enzyme cytochrome P450 (CYP) 3A4/5. It is frequently administered orally to children, yet knowledge is lacking on the oral bioavailability in term neonates up until 1 year of age. Furthermore, the dispositions of the major metabolites 1-OH-midazolam (OHM) and 1-OH-midazolam-glucuronide (OHMG) after oral administration are largely unknown for the entire pediatric age span. We aimed to fill these knowledge gaps with a pediatric [14 C]midazolam microtracer population pharmacokinetic study. Forty-six stable, critically ill children (median age 9.8 (range 0.3-276.4) weeks) received a single oral [14 C]midazolam microtracer (58 (40-67) Bq/kg) when they received a therapeutic continuous intravenous midazolam infusion and had an arterial line in place enabling blood sampling. For midazolam, in a one-compartment model, bodyweight was a significant predictor for clearance (0.98 L/hour) and volume of distribution (8.7 L) (values for a typical individual of 5 kg). The typical oral bioavailability in the population was 66% (range 25-85%). The exposures of OHM and OHMG were highest for the youngest age groups and significantly decreased with postnatal age. The oral bioavailability of midazolam, largely reflective of intestinal and hepatic CYP3A activity, was on average lower than the reported 49-92% for preterm neonates, and higher than the reported 21% for children> 1 year of age and 30% for adults. As midazolam oral bioavailability varied widely, systemic exposure of other CYP3A-substrate drugs after oral dosing in this population may also be unpredictable, with risk of therapy failure or toxicity.
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Affiliation(s)
- Bianca D. van Groen
- Intensive Care and Pediatric SurgeryErasmus Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | - Elke H. J. Krekels
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | - Miriam G. Mooij
- Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
| | | | | | - Albert D. Windhorst
- Amsterdam University Medical Centers – Location VU Medical CenterAmsterdamThe Netherlands
| | - Joost van Rosmalen
- Department of BiostatisticsErasmus Medical CenterRotterdamthe Netherlands
| | - Stan J. F. Hartman
- Department of Pharmacology and ToxicologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
| | - N. Harry Hendrikse
- Amsterdam University Medical Centers – Location VU Medical CenterAmsterdamThe Netherlands
| | - Birgit C. P. Koch
- Department of Hospital PharmacyErasmus Medical CenterRotterdamThe Netherlands
| | - Karel Allegaert
- Department of Hospital PharmacyErasmus Medical CenterRotterdamThe Netherlands
- Katholieke Universiteit LeuvenLeuvenBelgium
| | - Dick Tibboel
- Intensive Care and Pediatric SurgeryErasmus Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
| | - Catherijne A. J. Knibbe
- Leiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
- St Antonius HospitalNieuwegeinThe Netherlands
| | - Saskia N. de Wildt
- Intensive Care and Pediatric SurgeryErasmus Medical Center – Sophia Children’s HospitalRotterdamThe Netherlands
- Department of Pharmacology and ToxicologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
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3
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van Groen BD, Pilla Reddy V, Badée J, Olivares‐Morales A, Johnson TN, Nicolaï J, Annaert P, Smits A, de Wildt SN, Knibbe CAJ, de Zwart L. Pediatric Pharmacokinetics and Dose Predictions: A Report of a Satellite Meeting to the 10th Juvenile Toxicity Symposium. Clin Transl Sci 2021; 14:29-35. [PMID: 32702198 PMCID: PMC7877839 DOI: 10.1111/cts.12843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/13/2022] Open
Abstract
On April 24, 2019, a symposium on Pediatric Pharmacokinetics and Dose Predictions was held as a satellite meeting to the 10th Juvenile Toxicity Symposium. This symposium brought together scientists from academia, industry, and clinical research organizations with the aim to update each other on the current knowledge on pediatric drug development. Through more knowledge on specific ontogeny profiles of drug metabolism and transporter proteins, integrated into physiologically-based pharmacokinetic (PBPK) models, we have gained a more integrated understanding of age-related differences in pharmacokinetics (PKs), Relevant examples were presented during the meeting. PBPK may be considered the gold standard for pediatric PK prediction, but still it is important to know that simpler methods, such as allometry, allometry combined with maturation function, functions based on the elimination pathway, or linear models, also perform well, depending on the age range or the mechanisms involved. Knowledge from different methods and information sources should be combined (e.g., microdosing can reveal early read-out of age-related differences in exposure), and such results can be a value to verify models. To further establish best practices for dose setting in pediatrics, more in vitro and in vivo research is needed on aspects such as age-related changes in the exposure-response relationship and the impact of disease on PK. New information coupled with the refining of model-based drug development approaches will allow faster targeting of intended age groups and allow more efficient design of pediatric clinical trials.
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Affiliation(s)
- Bianca D. van Groen
- Intensive Care and Department of Pediatric SurgeryErasmus MC‐Sophia Children’s HospitalRotterdamThe Netherlands
- Roche Pharma and Early Development (pRED)Roche Innovation Center BaselBaselSwitzerland
| | | | - Justine Badée
- Center for Pharmacometrics & Systems PharmacologyDepartment of PharmaceuticsUniversity of Florida at Lake NonaOrlandoFloridaUSA
- Modelling & SimulationNovartis Institutes for Biomedical ResearchBaselSwitzerland
| | | | | | - Johan Nicolaï
- Development ScienceUCB BioPharma SRLBraine‐l’AlleudBelgium
| | - Pieter Annaert
- Drug Delivery and DispositionKU Leuven Department of Pharmaceutical and Pharmacological SciencesLeuvenBelgium
| | - Anne Smits
- Neonatal Intensive Care UnitUniversity Hospitals LeuvenLeuvenBelgium
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
| | - Saskia N. de Wildt
- Intensive Care and Department of Pediatric SurgeryErasmus MC‐Sophia Children’s HospitalRotterdamThe Netherlands
- Department of Pharmacology and ToxicologyRadboud Institute for Health SciencesRadboud UniversityNijmegenThe Netherlands
| | - Catherijne A. J. Knibbe
- Systems Biomedicine and PharmacologyLeiden Academic Center for Drug ResearchLeiden UniversityLeidenThe Netherlands
- Department of Clinical PharmacySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Loeckie de Zwart
- Drug Metabolism and PharmacokineticsJanssen R&D, a Division of Janssen Pharmaceutica NVBeerseBelgium
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Burt T, Young G, Lee W, Kusuhara H, Langer O, Rowland M, Sugiyama Y. Phase 0/microdosing approaches: time for mainstream application in drug development? Nat Rev Drug Discov 2020; 19:801-818. [PMID: 32901140 DOI: 10.1038/s41573-020-0080-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Phase 0 approaches - which include microdosing - evaluate subtherapeutic exposures of new drugs in first-in-human studies known as exploratory clinical trials. Recent progress extends phase 0 benefits beyond assessment of pharmacokinetics to include understanding of mechanism of action and pharmacodynamics. Phase 0 approaches have the potential to improve preclinical candidate selection and enable safer, cheaper, quicker and more informed developmental decisions. Here, we discuss phase 0 methods and applications, highlight their advantages over traditional strategies and address concerns related to extrapolation and developmental timelines. Although challenges remain, we propose that phase 0 approaches be at least considered for application in most drug development scenarios.
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Affiliation(s)
- Tal Burt
- Burt Consultancy LLC. talburtmd.com, New York, NY, USA. .,Phase-0/Microdosing Network. Phase-0Microdosing.org, New York, NY, USA.
| | - Graeme Young
- GlaxoSmithKline Research and Development Ltd, Ware, UK
| | - Wooin Lee
- Seoul National University, Seoul, Republic of Korea
| | | | - Oliver Langer
- Medical University of Vienna, Vienna, Austria.,AIT Austrian Institute of Technology GmbH, Vienna, Austria
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van Groen BD, Allegaert K, Tibboel D, de Wildt SN. Innovative approaches and recent advances in the study of ontogeny of drug metabolism and transport. Br J Clin Pharmacol 2020; 88:4285-4296. [PMID: 32851677 PMCID: PMC9545189 DOI: 10.1111/bcp.14534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022] Open
Abstract
The disposition of a drug is driven by various processes, such as drug metabolism, drug transport, glomerular filtration and body composition. These processes are subject to developmental changes reflecting growth and maturation along the paediatric continuum. However, knowledge gaps exist on these changes and their clinical impact. Filling these gaps may aid better prediction of drug disposition and creation of age-appropriate dosing guidelines. We present innovative approaches to study these developmental changes in relation to drug metabolism and transport. First, analytical methods such as including liquid chromatography-mass spectrometry for proteomic analyses allow quantitation of the expressions of a wide variety of proteins, e.g. membrane transporters, in a small piece of organ tissue. The latter is specifically important for paediatric research, where tissues are scarcely available. Second, innovative study designs using radioactive labelled microtracers allowed study-without risk for the child-of the oral bioavailability of compounds used as markers for certain drug metabolism pathways. Third, the use of modelling and simulation to support dosing recommendations for children is supported by both the European Medicines Agency and the US Food and Drug Administration. This may even do away with the need for a paediatric trial. Physiologically based pharmacokinetics models, which include age-specific physiological information are, therefore, increasingly being used, not only to aid paediatric drug development but also to improve existing drug therapies.
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Affiliation(s)
- Bianca D van Groen
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pharmacy and Pharmaceutical Sciences, KU Leuven, Leuven, Belgium.,Department of Clinical Pharmacy, Erasmus MC, Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Saskia N de Wildt
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Department of Pharmacology and Toxicology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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6
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van Groen BD, Vaes WH, Park BK, Krekels EHJ, van Duijn E, Kõrgvee LT, Maruszak W, Grynkiewicz G, Garner RC, Knibbe CAJ, Tibboel D, de Wildt SN, Turner MA. Dose-linearity of the pharmacokinetics of an intravenous [ 14 C]midazolam microdose in children. Br J Clin Pharmacol 2019; 85:2332-2340. [PMID: 31269280 PMCID: PMC6783587 DOI: 10.1111/bcp.14047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 01/27/2023] Open
Abstract
Aims Drug disposition in children may vary from adults due to age‐related variation in drug metabolism. Microdose studies present an innovation to study pharmacokinetics (PK) in paediatrics; however, they should be used only when the PK is dose linear. We aimed to assess dose linearity of a [14C]midazolam microdose, by comparing the PK of an intravenous (IV) microtracer (a microdose given simultaneously with a therapeutic midazolam dose), with the PK of a single isolated microdose. Methods Preterm to 2‐year‐old infants admitted to the intensive care unit received [14C]midazolam IV as a microtracer or microdose, followed by dense blood sampling up to 36 hours. Plasma concentrations of [14C]midazolam and [14C]1‐hydroxy‐midazolam were determined by accelerator mass spectrometry. Noncompartmental PK analysis was performed and a population PK model was developed. Results Of 15 infants (median gestational age 39.4 [range 23.9–41.4] weeks, postnatal age 11.4 [0.6–49.1] weeks), 6 received a microtracer and 9 a microdose of [14C]midazolam (111 Bq kg−1; 37.6 ng kg−1). In a 2‐compartment PK model, bodyweight was the most significant covariate for volume of distribution. There was no statistically significant difference in any PK parameter between the microdose and microtracer, nor in the area under curve ratio [14C]1‐OH‐midazolam/[14C]midazolam, showing the PK of midazolam to be linear within the range of the therapeutic and microdoses. Conclusion Our data support the dose linearity of the PK of an IV [14C]midazolam microdose in children. Hence, a [14C]midazolam microdosing approach may be used as an alternative to a therapeutic dose of midazolam to study developmental changes in hepatic CYP3A activity in young children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Catherijne A J Knibbe
- Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Dick Tibboel
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Saskia N de Wildt
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.,Radboud University, Nijmegen, the Netherlands
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Burt T, Vuong LT, Baker E, Young GC, McCartt AD, Bergstrom M, Sugiyama Y, Combes R. Phase 0, including microdosing approaches: Applying the Three Rs and increasing the efficiency of human drug development. Altern Lab Anim 2019; 46:335-346. [PMID: 30657329 DOI: 10.1177/026119291804600603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Phase 0 approaches, including microdosing, involve the use of sub-therapeutic exposures to the tested drugs, thus enabling safer, more-relevant, quicker and cheaper first-in-human (FIH) testing. These approaches also have considerable potential to limit the use of animals in human drug development. Recent years have witnessed progress in applications, methodology, operations, and drug development culture. Advances in applications saw an expansion in therapeutic areas, developmental scenarios and scientific objectives, in, for example, protein drug development and paediatric drug development. In the operational area, the increased sensitivity of Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS), expansion of the utility of Positron Emission Tomography (PET) imaging, and the introduction of Cavity Ring-Down Spectroscopy (CRDS), have led to the increased accessibility and utility of Phase 0 approaches, while reducing costs and exposure to radioactivity. PET has extended the application of microdosing, from its use as a predominant tool to record pharmacokinetics, to a method for recording target expression and target engagement, as well as cellular and tissue responses. Advances in methodology include adaptive Phase 0/Phase 1 designs, cassette and cocktail microdosing, and Intra-Target Microdosing (ITM), as well as novel modelling opportunities and simulations. Importantly, these methodologies increase the predictive power of extrapolation from microdose to therapeutic level exposures. However, possibly the most challenging domain in which progress has been made, is the culture of drug development. One of the main potential values of Phase 0 approaches is the opportunity to terminate development early, thus not only applying the principle of 'kill-early-kill-cheap' to enhance the efficiency of drug development, but also obviating the need for the full package of animal testing required for therapeutic level Phase 1 studies. Finally, we list developmental scenarios that utilised Phase 0 approaches in novel drug development.
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Affiliation(s)
- Tal Burt
- Burt Consultancy, LLC, Durham, NC, USA
| | | | - Elizabeth Baker
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Graeme C Young
- Translational Medicine, Research, GSK, David Jack Centre for R&D, Ware, Hertfordshire, UK
| | | | - Mats Bergstrom
- Department of Pharmacology and PET-centre, Uppsala University, Uppsala, Sweden
| | - Yuichi Sugiyama
- Sugiyama Laboratory, RIKEN Innovation Center, RIKEN (The Institute of Physical and Chemical Research(, Yokohama, Kanagawa, Japan
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Mooij MG, van Duijn E, Knibbe CAJ, Allegaert K, Windhorst AD, van Rosmalen J, Hendrikse NH, Tibboel D, Vaes WHJ, de Wildt SN. Successful Use of [ 14C]Paracetamol Microdosing to Elucidate Developmental Changes in Drug Metabolism. Clin Pharmacokinet 2018; 56:1185-1195. [PMID: 28155137 PMCID: PMC5591809 DOI: 10.1007/s40262-017-0508-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background We previously showed the practical and ethical feasibility of using [14C]-microdosing for pharmacokinetic studies in children. We now aimed to show that this approach can be used to elucidate developmental changes in drug metabolism, more specifically, glucuronidation and sulfation, using [14C]paracetamol (AAP). Methods Infants admitted to the intensive care unit received a single oral [14C]AAP microdose while receiving intravenous therapeutic AAP every 6 h. [14C]AAP pharmacokinetic parameters were estimated. [14C]AAP and metabolites were measured with accelerator mass spectrometry. The plasma area under the concentration-time curve from time zero to infinity and urinary recovery ratios were related to age as surrogate markers of metabolism. Results Fifty children [median age 6 months (range 3 days–6.9 years)] received a microdose (3.3 [2.0–3.5] ng/kg; 64 [41–71] Bq/kg). Plasma [14C]AAP apparent total clearance was 0.4 (0.1–2.6) L/h/kg, apparent volume of distribution was 1.7 (0.9–8.2) L/kg, and the half-life was 2.8 (1–7) h. With increasing age, plasma and urinary AAP-glu/AAP and AAP-glu/AAP-sul ratios significantly increased by four fold, while the AAP-sul/AAP ratio significantly decreased. Conclusion Using [14C]labeled microdosing, the effect of age on orally administered AAP metabolism was successfully elucidated in both plasma and urine. With minimal burden and risk, microdosing is attractive to study developmental changes in drug disposition in children.
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Affiliation(s)
- Miriam G Mooij
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Catherijne A J Knibbe
- Division of Pharmacology, Faculty of Science, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Karel Allegaert
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - N Harry Hendrikse
- Department of Pharmacy and Clinical Pharmacology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Saskia N de Wildt
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
- Department of Pharmacology and Toxicology, Radboud University, PO box 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, The Netherlands.
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Enright HA, Malfatti MA, Zimmermann M, Ognibene T, Henderson P, Turteltaub KW. Use of Accelerator Mass Spectrometry in Human Health and Molecular Toxicology. Chem Res Toxicol 2016; 29:1976-1986. [PMID: 27726383 PMCID: PMC5203773 DOI: 10.1021/acs.chemrestox.6b00234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accelerator mass spectrometry (AMS) has been adopted as a powerful bioanalytical method for human studies in the areas of pharmacology and toxicology. The exquisite sensitivity (10-18 mol) of AMS has facilitated studies of toxins and drugs at environmentally and physiologically relevant concentrations in humans. Such studies include risk assessment of environmental toxicants, drug candidate selection, absolute bioavailability determination, and more recently, assessment of drug-target binding as a biomarker of response to chemotherapy. Combining AMS with complementary capabilities such as high performance liquid chromatography (HPLC) can maximize data within a single experiment and provide additional insight when assessing drugs and toxins, such as metabolic profiling. Recent advances in the AMS technology at Lawrence Livermore National Laboratory have allowed for direct coupling of AMS with complementary capabilities such as HPLC via a liquid sample moving wire interface, offering greater sensitivity compared to that of graphite-based analysis, therefore enabling the use of lower 14C and chemical doses, which are imperative for clinical testing. The aim of this review is to highlight the recent efforts in human studies using AMS, including technological advancements and discussion of the continued promise of AMS for innovative clinical based research.
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Affiliation(s)
- Heather A. Enright
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, CA USA
| | - Michael A. Malfatti
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, CA USA
| | - Maike Zimmermann
- Department of Internal Medicine, Division of Hematology and Oncology, UC Davis Medical Center, Sacramento, CA USA
- Accelerated Medical Diagnostics Incorporated, Berkeley, CA USA
| | - Ted Ognibene
- Center for Accelerator Mass Spectrometry, Lawrence Livermore National Laboratory, Livermore, CA USA
| | - Paul Henderson
- Department of Internal Medicine, Division of Hematology and Oncology, UC Davis Medical Center, Sacramento, CA USA
- Accelerated Medical Diagnostics Incorporated, Berkeley, CA USA
| | - Kenneth W. Turteltaub
- Biosciences and Biotechnology Division, Lawrence Livermore National Laboratory, Livermore, CA USA
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10
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Burt T, John CS, Ruckle JL, Vuong LT. Phase-0/microdosing studies using PET, AMS, and LC-MS/MS: a range of study methodologies and conduct considerations. Accelerating development of novel pharmaceuticals through safe testing in humans – a practical guide. Expert Opin Drug Deliv 2016; 14:657-672. [DOI: 10.1080/17425247.2016.1227786] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Suri A, Pusalkar S, Li Y, Prakash S. Absorption, Distribution, and Excretion of the Investigational Agent Orteronel (TAK-700) in Healthy Male Subjects: A Phase 1, Open-Label, Single-Dose Study. Clin Pharmacol Drug Dev 2016; 5:180-7. [DOI: 10.1002/cpdd.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ajit Suri
- Millennium Pharmaceuticals; Inc; a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge MA USA
| | - Sandeepraj Pusalkar
- Millennium Pharmaceuticals; Inc; a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge MA USA
| | - Yuexian Li
- Millennium Pharmaceuticals; Inc; a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge MA USA
| | - Shimoga Prakash
- Millennium Pharmaceuticals; Inc; a wholly owned subsidiary of Takeda Pharmaceutical Company Limited; Cambridge MA USA
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12
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Burt T, Yoshida K, Lappin G, Vuong L, John C, de Wildt SN, Sugiyama Y, Rowland M. Microdosing and Other Phase 0 Clinical Trials: Facilitating Translation in Drug Development. Clin Transl Sci 2016; 9:74-88. [PMID: 26918865 PMCID: PMC5351314 DOI: 10.1111/cts.12390] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 12/13/2022] Open
Affiliation(s)
- T Burt
- Principal, Burt Consultancy, Durham, NC, 27705, USA
| | - K Yoshida
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA.,Oak Ridge Institution for Science and Education (ORISE) Fellow
| | - G Lappin
- Visiting Professor of Pharmacology School of Pharmacy University of Lincoln, Joseph Banks Laboratories, Lincoln, LN6 7DL, UK
| | - L Vuong
- Principal, LTV Consulting, Davis, CA, USA.,Clinical Advisor at BioCore, Seoul, South Korea
| | - C John
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - S N de Wildt
- Intensive Care and Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Y Sugiyama
- Sugiyama Laboratory, RIKEN Innovation Center, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - M Rowland
- Centre for Applied Pharmacokinetic Research, University of Manchester, Manchester, M13 9PT, UK.,Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, USA
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13
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Opportunities in low-level radiocarbon microtracing: applications and new technology. Future Sci OA 2015; 2:FSO74. [PMID: 28031933 PMCID: PMC5137946 DOI: 10.4155/fso.15.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/20/2015] [Indexed: 12/14/2022] Open
Abstract
14C-radiolabeled (radiocarbon) drug studies are central to defining the disposition of therapeutics in clinical development. Concerns over radiation, however, have dissuaded investigators from conducting these studies as often as their utility may merit. Accelerator mass spectrometry (AMS), originally designed for carbon dating and geochronology, has changed the outlook for in-human radiolabeled testing. The high sensitivity of AMS affords human clinical testing with vastly reduced radiative (microtracing) and chemical exposures (microdosing). Early iterations of AMS were unsuitable for routine biomedical use due to the instruments' large size and associated per sample costs. The situation is changing with advances in the core and peripheral instrumentation. We review the important milestones in applied AMS research and recent advances in the core technology platform. We also look ahead to an entirely new class of 14C detection systems that use lasers to measure carbon dioxide in small gas cells.
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Svendsen P, El-Galaly TC, Dybkær K, Bøgsted M, Laursen MB, Schmitz A, Jensen P, Johnsen HE. The application of human phase 0 microdosing trials: A systematic review and perspectives. Leuk Lymphoma 2015; 57:1281-90. [PMID: 26428262 DOI: 10.3109/10428194.2015.1101097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A decreasing number of new therapeutic drugs reaching the clinic has led to the publication of regulatory guidelines on human microdosing trials by the European Medicines Agency in 2004 and the US Food and Drug Administration in 2006. Microdosing trials are defined by the administration of 1/100th of the therapeutic dose and designed to investigate basic drug properties. This review investigates the current application of phase 0 trials in medical research. Thirty-three studies found in PubMed and EMBASE were systematically reviewed for aim and analytical method. Pharmacokinetic studies have been a major focus of phase 0 trials, but drug distribution, drug-drug interactions, imaging and pharmacogenomics have also been investigated. Common analytical methods were tandem mass liquid chromatography, accelerator mass spectrometry and positron emission tomography. New ongoing trials are investigating the pharmacodynamics and chemoresistance of marketed drugs, suggesting that the application of phase 0 trials is still evolving.
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Affiliation(s)
| | - Tarec C El-Galaly
- a Department of Hematology , Aalborg University Hospital , Denmark.,b Department of Clinical Medicine , Aalborg University , Denmark.,c Clinical Cancer Research Center, Aalborg University Hospital , Denmark
| | - Karen Dybkær
- a Department of Hematology , Aalborg University Hospital , Denmark.,b Department of Clinical Medicine , Aalborg University , Denmark.,c Clinical Cancer Research Center, Aalborg University Hospital , Denmark
| | - Martin Bøgsted
- a Department of Hematology , Aalborg University Hospital , Denmark.,b Department of Clinical Medicine , Aalborg University , Denmark.,c Clinical Cancer Research Center, Aalborg University Hospital , Denmark
| | - Maria B Laursen
- a Department of Hematology , Aalborg University Hospital , Denmark
| | - Alexander Schmitz
- a Department of Hematology , Aalborg University Hospital , Denmark.,c Clinical Cancer Research Center, Aalborg University Hospital , Denmark
| | - Paw Jensen
- a Department of Hematology , Aalborg University Hospital , Denmark
| | - Hans E Johnsen
- a Department of Hematology , Aalborg University Hospital , Denmark.,b Department of Clinical Medicine , Aalborg University , Denmark.,c Clinical Cancer Research Center, Aalborg University Hospital , Denmark
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15
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Lappin G. The expanding utility of microdosing. Clin Pharmacol Drug Dev 2015; 4:401-6. [DOI: 10.1002/cpdd.235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/09/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Graham Lappin
- Visiting Professor of Pharmacology; University of Lincoln, School of Pharmacy, Joseph Banks Laboratories; Lincoln UK
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16
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Brouwer KLR, Aleksunes LM, Brandys B, Giacoia GP, Knipp G, Lukacova V, Meibohm B, Nigam SK, Rieder M, de Wildt SN. Human Ontogeny of Drug Transporters: Review and Recommendations of the Pediatric Transporter Working Group. Clin Pharmacol Ther 2015; 98:266-87. [PMID: 26088472 DOI: 10.1002/cpt.176] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 12/19/2022]
Abstract
The critical importance of membrane-bound transporters in pharmacotherapy is widely recognized, but little is known about drug transporter activity in children. In this white paper, the Pediatric Transporter Working Group presents a systematic review of the ontogeny of clinically relevant membrane transporters (e.g., SLC, ABC superfamilies) in intestine, liver, and kidney. Different developmental patterns for individual transporters emerge, but much remains unknown. Recommendations to increase our understanding of membrane transporters in pediatric pharmacotherapy are presented.
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Affiliation(s)
- K L R Brouwer
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - L M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers, the State University of New Jersey, Ernest Mario School of Pharmacy, Piscataway, New Jersey, USA
| | - B Brandys
- NIH Library, National Institutes of Health, Bethesda, Maryland, USA
| | - G P Giacoia
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, USA
| | - G Knipp
- College of Pharmacy, Department of Industrial and Physical Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - V Lukacova
- Simulations Plus, lnc., Lancaster, California, USA
| | - B Meibohm
- University of Tennessee Health Science Center, College of Pharmacy, Memphis, Tennessee, USA
| | - S K Nigam
- University of California San Diego, La Jolla, California, USA
| | - M Rieder
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - S N de Wildt
- Erasmus MC Sophia Children's Hospital, Intensive Care and Department of Pediatric Surgery, Rotterdam, the Netherlands
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17
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Turner MA, Mooij MG, Vaes WHJ, Windhorst AD, Hendrikse NH, Knibbe CAJ, Kõrgvee LT, Maruszak W, Grynkiewicz G, Garner RC, Tibboel D, Park BK, de Wildt SN. Pediatric microdose and microtracer studies using 14C in Europe. Clin Pharmacol Ther 2015; 98:234-7. [PMID: 26095095 DOI: 10.1002/cpt.163] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Important information gaps remain on the efficacy and safety of drugs in children. Pediatric drug development encounters several ethical, practical, and scientific challenges. One barrier to the evaluation of medicines for children is a lack of innovative methodologies that have been adapted to the needs of children. This article presents our successful experience of pediatric microdose and microtracer studies using (14) C-labeled probes in Europe to illustrate the strengths and limitations of these approaches.
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Affiliation(s)
- M A Turner
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M G Mooij
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - A D Windhorst
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - N H Hendrikse
- Department of Clinical Pharmacology & Pharmacy, Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C A J Knibbe
- Faculty of Science, Leiden Academic Centre for Research, Pharmacology, Leiden, The Netherlands.,Hospital Pharmacy and Clinical Pharmacology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - L T Kõrgvee
- Department of Clinical Pharmacology, University of Tartu, Tartu, Estonia
| | - W Maruszak
- R&D Analytical Chemistry Department, Pharmaceutical Research Institute, Warsaw, Poland
| | | | - R C Garner
- Garner Consulting and Hull York Medical School, University of York, York, UK
| | - D Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B K Park
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - S N de Wildt
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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18
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Pediatric microdose study of [(14)C]paracetamol to study drug metabolism using accelerated mass spectrometry: proof of concept. Clin Pharmacokinet 2015; 53:1045-51. [PMID: 25227283 PMCID: PMC4213380 DOI: 10.1007/s40262-014-0176-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pediatric drug development is hampered by practical, ethical, and scientific challenges. Microdosing is a promising new method to obtain pharmacokinetic data in children with minimal burden and minimal risk. The use of a labeled oral microdose offers the added benefit to study intestinal and hepatic drug disposition in children already receiving an intravenous therapeutic drug dose for clinical reasons. OBJECTIVE The objective of this study was to present pilot data of an oral [(14)C]paracetamol [acetaminophen (AAP)] microdosing study as proof of concept to study developmental pharmacokinetics in children. METHODS In an open-label microdose pharmacokinetic pilot study, infants (0-6 years of age) received a single oral [(14)C]AAP microdose (3.3 ng/kg, 60 Bq/kg) in addition to intravenous therapeutic doses of AAP (15 mg/kg intravenous every 6 h). Blood samples were taken from an indwelling catheter. AAP blood concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and [(14)C]AAP and metabolites ([(14)C]AAP-Glu and [(14)C]AAP-4Sul) were measured by accelerator mass spectrometry. RESULTS Ten infants (aged 0.1-83.1 months) were included; one was excluded as he vomited shortly after administration. In nine patients, [(14)C]AAP and metabolites in blood samples were detectable at expected concentrations: median (range) maximum concentration (C max) [(14)C]AAP 1.68 (0.75-4.76) ng/L, [(14)C]AAP-Glu 0.88 (0.34-1.55) ng/L, and [(14)C]AAP-4Sul 0.81 (0.29-2.10) ng/L. Dose-normalized oral [(14)C]AAP C max approached median intravenous average concentrations (C av): 8.41 mg/L (3.75-23.78 mg/L) and 8.87 mg/L (3.45-12.9 mg/L), respectively. CONCLUSIONS We demonstrate the feasibility of using a [(14)C]labeled microdose to study AAP pharmacokinetics, including metabolite disposition, in young children.
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Samardzic J, Turner MA, Bax R, Allegaert K. Neonatal medicines research: challenges and opportunities. Expert Opin Drug Metab Toxicol 2015; 11:1041-52. [PMID: 25958820 DOI: 10.1517/17425255.2015.1046433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The key feature of the newborn is its fast age-dependent maturation, resulting in extensive variability in pharmacokinetics and -dynamics, further aggravated by newly emerging covariates like treatment modalities, environmental issues or pharmacogenetics. This makes clinical research in neonates relevant and needed, but also challenging. AREAS COVERED To improve this knowledge, tailoring research tools as well as building research networks and clinical research skills for neonates are urgently needed. Tailoring of research tools is illustrated using the development of dried blood spot techniques and the introduction of micro-dosing and -tracer methodology in neonatal drug studies. Both techniques can be combined with sparse sampling techniques through population modeling. Building research networks and clinical research skills is illustrated by the initiatives of agencies to build and integrate knowledge on neonatal pharmacotherapy through dedicated working groups. EXPERT OPINION Challenges relating to neonatal medicine research can largely be overcome. Tailored tools and legal initiatives, combined with clever trial design will result in more robust information on neonatal pharmacotherapy. This necessitates collaborative efforts between clinical researchers, sponsors, regulatory authorities, and last but not least patient representatives and society.
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Affiliation(s)
- Janko Samardzic
- University of Belgrade, Institute of Pharmacology, Clinical Pharmacology and Toxicology, Medical Faculty, Belgrade, Serbia
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20
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Kleiber N, Tromp K, Mooij MG, van de Vathorst S, Tibboel D, de Wildt SN. Ethics of drug research in the pediatric intensive care unit. Paediatr Drugs 2015; 17:43-53. [PMID: 25354987 DOI: 10.1007/s40272-014-0101-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Critical illness and treatment modalities change pharmacokinetics and pharmacodynamics of medications used in critically ill children, in addition to age-related changes in drug disposition and effect. Hence, to ensure effective and safe drug therapy, research in this population is urgently needed. However, conducting research in the vulnerable population of the pediatric intensive care unit (PICU) presents with ethical challenges. This article addresses the main ethical issues specific to drug research in these critically ill children and proposes several solutions. The extraordinary environment of the PICU raises specific challenges to the design and conduct of research. The need for proxy consent of parents (or legal guardians) and the stress-inducing physical environment may threaten informed consent. The informed consent process is challenging because emergency research reduces or even eliminates the time to seek consent. Moreover, parental anxiety may impede adequate understanding and generate misconceptions. Alternative forms of consent have been developed taking into account the unpredictable reality of the acute critical care environment. As with any research in children, the burden and risk should be minimized. Recent developments in sample collection and analysis as well as pharmacokinetic analysis should be considered in the design of studies. Despite the difficulties inherent to drug research in critically ill children, methods are available to conduct ethically sound research resulting in relevant and generalizable data. This should motivate the PICU community to commit to drug research to ultimately provide the right drug at the right dose for every individual child.
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Affiliation(s)
- Niina Kleiber
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
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21
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van Duijn E, Sandman H, Grossouw D, Mocking JAJ, Coulier L, Vaes WHJ. Automated Combustion Accelerator Mass Spectrometry for the Analysis of Biomedical Samples in the Low Attomole Range. Anal Chem 2014; 86:7635-41. [DOI: 10.1021/ac5015035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Hugo Sandman
- TNO, P.O. Box 360, 3700AJ Zeist, The Netherlands
| | | | | | - Leon Coulier
- TNO, P.O. Box 360, 3700AJ Zeist, The Netherlands
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22
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Gordi T, Baillie R, Vuong LT, Abidi S, Dueker S, Vasquez H, Pegis P, Hopper AO, Power GG, Blood AB. Pharmacokinetic analysis of14C-ursodiol in newborn infants using accelerator mass spectrometry. J Clin Pharmacol 2014; 54:1031-7. [DOI: 10.1002/jcph.327] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 04/30/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Le T. Vuong
- Eckert & Ziegler Vitalea Science; Davis CA USA
| | - Saira Abidi
- Eckert & Ziegler Vitalea Science; Davis CA USA
| | | | - Herbert Vasquez
- Division of Neonatology; Department of Pediatrics; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Priscilla Pegis
- Division of Neonatology; Department of Pediatrics; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Andrew O. Hopper
- Division of Neonatology; Department of Pediatrics; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Gordon G. Power
- Center for Perinatal Biology; Loma Linda University School of Medicine; Loma Linda CA USA
| | - Arlin B. Blood
- Division of Neonatology; Department of Pediatrics; Loma Linda University School of Medicine; Loma Linda CA USA
- Center for Perinatal Biology; Loma Linda University School of Medicine; Loma Linda CA USA
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Dave M, Nash M, Young GC, Ellens H, Magee MH, Roberts AD, Taylor MA, Greenhill RW, Boyle GW. Disposition and metabolism of darapladib, a lipoprotein-associated phospholipase A2 inhibitor, in humans. Drug Metab Dispos 2013; 42:415-30. [PMID: 24378325 DOI: 10.1124/dmd.113.054486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The absorption, metabolism, and excretion of darapladib, a novel inhibitor of lipoprotein-associated phospholipase A2, was investigated in healthy male subjects using [(14)C]-radiolabeled material in a bespoke study design. Disposition of darapladib was compared following single i.v. and both single and repeated oral administrations. The anticipated presence of low circulating concentrations of drug-related material required the use of accelerator mass spectrometry as a sensitive radiodetector. Blood, urine, and feces were collected up to 21 days post radioactive dose, and analyzed for drug-related material. The principal circulating drug-related component was unchanged darapladib. No notable metabolites were observed in plasma post-i.v. dosing; however, metabolites resulting from hydroxylation (M3) and N-deethylation (M4) were observed (at 4%-6% of plasma radioactivity) following oral dosing, indicative of some first-pass metabolism. In addition, an acid-catalyzed degradant (M10) resulting from presystemic hydrolysis was also detected in plasma at similar levels of ∼5% of radioactivity post oral dosing. Systemic exposure to radioactive material was reduced within the repeat dose regimen, consistent with the notion of time-dependent pharmacokinetics resulting from enhanced clearance or reduced absorption. Elimination of drug-related material occurred predominantly via the feces, with unchanged darapladib representing 43%-53% of the radioactive dose, and metabolites M3 and M4 also notably accounting for ∼9% and 19% of the dose, respectively. The enhanced study design has provided an increased understanding of the absorption, distribution, metabolism and excretion (ADME) properties of darapladib in humans, and substantially influenced future work on the compound.
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Affiliation(s)
- Mehul Dave
- Department of Drug Metabolism and Pharmacokinetics (M.D., M.N., G.C.Y., A.D.R., M.A.T., G.W.B.) and Department of Safety Assessment (R.W.G.), GlaxoSmithKline Research & Development, Ware, United Kingdom, and Department of Drug Metabolism and Pharmacokinetics (H.E.) and Clinical Pharmacology, Modeling and Simulation (M.H.M.), GlaxoSmithKline Research & Development, Upper Merion, Philadelphia
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Iodine-129 microdosing for protein and peptide drug development: erythropoietin as a case study. Bioanalysis 2013; 5:53-63. [PMID: 23256472 DOI: 10.4155/bio.12.297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Microdosing is a technique for studying the behavior of compounds in vivo at 1/100th of the dose of a test substance calculated, based on animal data, to yield a pharmacologic effect. In microdosing, use is made of accelerator MS (AMS). In this study, we investigated whether (129)I-labeling of proteins with subsequent AMS measurements is a suitable method to perform microdose studies with therapeutic proteins. We used erythropoietin (EPO) as a case study. RESULTS In an animal study with (129)I-labeled EPO in Han-Wistar rats, an increase of (129)I-EPO is observed after dose administration. The half-life was found to be 2 and 5.5 h for two different EPOs. These results are in accordance with expected values. CONCLUSION Although further research is required, (129)I-labeling of proteins seems a feasible method for AMS microdose studies with peptide and protein drugs, such as biosimilars.
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Lappin G, Noveck R, Burt T. Microdosing and drug development: past, present and future. Expert Opin Drug Metab Toxicol 2013; 9:817-34. [PMID: 23550938 DOI: 10.1517/17425255.2013.786042] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Microdosing is an approach to early drug development where exploratory pharmacokinetic data are acquired in humans using inherently safe sub-pharmacologic doses of drug. The first publication of microdose data was 10 years ago and this review comprehensively explores the microdose concept from conception, over the past decade, up until the current date. AREAS COVERED The authors define and distinguish the concept of microdosing from similar approaches. The authors review the ability of microdosing to provide exploratory pharmacokinetics (concentration-time data) but exclude microdosing using positron emission tomography. The article provides a comprehensive review of data within the peer-reviewed literature as well as the latest applications and a look into the future, towards where microdosing may be headed. EXPERT OPINION Evidence so far suggests that microdosing may be a better predictive tool of human pharmacokinetics than alternative methods and combination with physiologically based modelling may lead to much more reliable predictions in the future. The concept has also been applied to drug-drug interactions, polymorphism and assessing drug concentrations over time at its site of action. Microdosing may yet have more to offer in unanticipated directions and provide benefits that have not been fully realised to date.
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Affiliation(s)
- Graham Lappin
- University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK.
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