Curtis SA, Friedman E, Minniti C, Nguyen Dang A, Pochron M, Thomas M, Betancourt J, Vattappally L, Crouch A, Morales J, Campbell ST. Concentration of voxelotor in sickle cell disease can be estimated using electrophoresis and high-performance liquid chromatography.
Am J Clin Pathol 2024:aqae042. [PMID:
38639326 DOI:
10.1093/ajcp/aqae042]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES
Voxelotor can increase hemoglobin levels in patients living with sickle cell disease (SCD). A clinician who is monitoring voxelotor response may want to know whole-blood voxelotor concentration, but this cannot be measured in most clinical settings. However, voxelotor has been demonstrated to cause "peak splitting" in common methods of hemoglobin measurement such as capillary zone electrophoresis (CZE) and high-performance liquid chromatography (HPLC). We hypothesized that we could use the size of the peak split to estimate the whole-blood concentration.
METHODS
Blood from people with SCD was dosed with known concentrations of voxelotor, and multiparameter regression was used to derive the relationship of voxelotor concentration to the degree of peak splitting observed. To validate these equations, 21 patients started on voxelotor at 1500 mg/d had blood samples drawn at days 0, 14, 30, and 60. Samples were sent out for gold standard voxelotor concentration testing. The derived equations were then used to calculate voxelotor concentration.
RESULTS
Calculated concentrations correlated strongly with measured concentrations for both CZE (R2 = 0.83, P < .001) and HPLC (R2 = 0.76, P < .001). Voxelotor concentration also had a significant effect on increases in hemoglobin (R2 = 0.40, P < .001).
CONCLUSIONS
Thus, peak splitting CZE and HPLC can be used to estimate voxelotor concentration.
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