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Ariaans G, Tiersma JF, Evers B, Gerding A, Waaijer SJH, Koster RA, Touw DJ, Bakker BM, Reijngoud DJ, de Jong S, Jalving M. Everolimus decreases [U- 13C]glucose utilization by pyruvate carboxylase in breast cancer cells in vitro and in vivo. Biomed Pharmacother 2024; 173:116362. [PMID: 38432130 DOI: 10.1016/j.biopha.2024.116362] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
Reprogrammed metabolism is a hallmark of cancer, but notoriously difficult to target due to metabolic plasticity, especially in response to single metabolic interventions. Combining mTOR inhibitor everolimus and mitochondrial complex 1 inhibitor metformin results in metabolic synergy in in vitro models of triple-negative breast cancer. Here, we investigated whether the effect of this drug combination on tumor size is reflected in changes in tumor metabolism using [U-13C]glucose labeling in an MDA-MB-231 triple negative breast cancer xenograft model. The in vitro effects of everolimus and metformin treatment on oxidative phosphorylation and glycolysis reflected changes in 13C-labeling of metabolites in MDA-MB-231 cells. Treatment of MDA-MB-231 xenografts in SCID/Beige mice with everolimus resulted in slower tumor growth and reduced tumor size and tumor viability by 35%. Metformin treatment moderately inhibited tumor growth but did not enhance everolimus-induced effects. High serum levels of everolimus were reached, whereas levels of metformin were relatively low. Everolimus decreased TCA cycle metabolite labeling and inhibited pyruvate carboxylase activity. Metformin only caused a mild reduction in glycolytic metabolite labeling and did not affect pyruvate carboxylase activity or TCA cycle metabolite labeling. In conclusion, treatment with everolimus, but not metformin, decreased tumor size and viability. Furthermore, the efficacy of everolimus was reflected in reduced 13C-labeling of TCA cycle intermediates and reduced pyruvate carboxylase activity. By using in-depth analysis of drug-induced changes in glucose metabolism in combination with measurement of drug levels in tumor and plasma, effects of metabolically targeted drugs can be explained, and novel targets can be identified.
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Affiliation(s)
- Gerke Ariaans
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jiske F Tiersma
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bernardus Evers
- Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Albert Gerding
- Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stijn J H Waaijer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Remco A Koster
- Department of Clinical Pharmacy and Pharmacology, Laboratory for Clinical and Forensic Toxicology and Drugs Analysis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, Laboratory for Clinical and Forensic Toxicology and Drugs Analysis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Barbara M Bakker
- Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk-Jan Reijngoud
- Department of Pediatrics, Center for Liver, Digestive and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Steven de Jong
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Mathilde Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Iersel TV, Courville J, Doorne CV, Koster RA, Fawcett C. The Patient Motivation Pyramid and Patient-Centricity in Early Clinical Development. Curr Rev Clin Exp Pharmacol 2021; 17:8-17. [DOI: 10.2174/1574884716666210427115820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
Background:
It is increasingly recognized that patients should be involved in the design of clinical trials. However, there is a lack in agreement of what patient-centricity means.
Methods:
In this article a Patient Motivation Pyramid based on Maslow’s theory of human motivation is introduced as a tool to identify patient needs. This pyramid is used to make a comprehensive overview of options to implement patient-centric trial design. The Pyramid with the described options can help to identify patient-centric activities suitable for a given drug development. The current article further describes potential benefits of patient-centric trial designs with an emphasis on early clinical development. Especially in early clinical development during which trials have many assessments per patient, and the safety and clinical efficacy are uncertain, patient-centric trial design can improve feasibility. Finally, we present three case examples on patient-centric trial design. The first example is seeking patient input on the trial design for a First-in-Human trial which includes patients with Immune Thrombocytopenic Purpura. The second example is the use of a video link for home dosing. The final example is the use of digital medicine in a trial in heart failure patients.
Results:
A comprehensive overview of patients’ needs can be accomplished by building a Patient Motivation Pyramid as a tool. Patient input can lead to improved endpoints, improved feasibility, better recruitment, less dropout, less protocol amendments, and higher patient satisfaction. The use of digital medicine can lead to a trial design with much less visits to the clinical research center in early clinical development, and in a later development phase even to a complete virtual trial.
Conclusion:
We recommend using the Patient Motivation Pyramid as structural approach for identifying elements of patient-centricity. Secondly we recommend to start using patient-centric approaches in an early phase of the medicine’s lifecycle.
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Affiliation(s)
- Thijs van Iersel
- PRA Health Sciences, Scientific Affairs-Clinical Pharmacology, Groningen, Netherlands
| | - Jocelyn Courville
- PRA Health Sciences, Scientific Affairs-Clinical Pharmacology, Blue Bell, PA, United States
| | - Cathalijne van Doorne
- Patient representative PRAC EMA, Vice President of the European Federation of Neurological Associations, Belgium
| | - Remco A. Koster
- PRA Health Sciences, Bioanalytical Laboratory; Assen, Netherlands
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Veenhof H, Koster RA, Brinkman R, Senturk E, Bakker SJL, Berger SP, Akkerman OW, Touw DJ, Alffenaar JWC. Performance of a web-based application measuring spot quality in dried blood spot sampling. Clin Chem Lab Med 2020; 57:1846-1853. [PMID: 31373896 DOI: 10.1515/cclm-2019-0437] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
Background The dried blood spot (DBS) method allows patients and researchers to collect blood on a sampling card using a skin-prick. An important issue in the application of DBSs is that samples for therapeutic drug monitoring are frequently rejected because of poor spot quality, leading to delayed monitoring or missing data. We describe the development and performance of a web-based application (app), accessible on smartphones, tablets or desktops, capable of assessing DBS quality at the time of sampling by means of analyzing a picture of the DBS. Methods The performance of the app was compared to the judgment of experienced laboratory technicians for samples obtained in a trained and untrained setting. A robustness- and user test were performed. Results In a trained setting the app yielded an adequate decision in 90.0% of the cases with 4.1% false negatives (insufficient quality DBSs incorrectly not rejected) and 5.9% false positives (sufficient quality DBSs incorrectly rejected). In an untrained setting this was 87.4% with 5.5% false negatives and 7.1% false positives. A patient user test resulted in a system usability score of 74 out of 100 with a median time of 1 min and 45 s to use the app. Robustness testing showed a repeatability of 84%. Using the app in a trained and untrained setting improves the amount of sufficient quality samples from 80% to 95.9% and 42.2% to 87.9%, respectively. Conclusions The app can be used in trained and untrained setting to decrease the amount of insufficient quality DBS samples.
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Affiliation(s)
- Herman Veenhof
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Remco A Koster
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Science Department - LC-MS/MS, PRA Health Sciences, Assen, The Netherlands
| | | | - Enes Senturk
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Westmead Hospital, Sydney, Australia
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Veenhof H, Koster RA, Junier LA, Berger SP, Bakker SJ, Touw DJ. Volumetric absorptive microsampling and dried blood spot microsampling vs. conventional venous sampling for tacrolimus trough concentration monitoring. ACTA ACUST UNITED AC 2020; 58:1687-1695. [DOI: 10.1515/cclm-2019-1260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/27/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Objectives
Monitoring tacrolimus blood concentrations is important for preventing allograft rejection in transplant patients. Our hospital offers dried blood spot (DBS) sampling, giving patients the opportunity to sample a drop of blood from a fingerprick at home, which can be sent to the laboratory by mail. In this study, both a volumetric absorptive microsampling (VAMS) device and DBS sampling were compared to venous whole blood (WB) sampling.
Methods
A total of 130 matched fingerprick VAMS, fingerprick DBS and venous WB samples were obtained from 107 different kidney transplant patients by trained phlebotomists for method comparison using Passing-Bablok regression. Bias was assessed using Bland-Altman. A multidisciplinary team pre-defined an acceptance limit requiring >80% of all matched samples within 15% of the mean of both samples. Sampling quality was evaluated for both VAMS and DBS samples.
Results
32.3% of the VAMS samples and 6.2% of the DBS samples were of insufficient quality, leading to 88 matched samples fit for analysis. Passing-Bablok regression showed a significant difference between VAMS and WB, with a slope of 0.88 (95% CI 0.81–0.97) but not for DBS (slope 1.00; 95% CI 0.95–1.04). Both VAMS (after correction for the slope) and DBS showed no significant bias in Bland-Altman analysis. For VAMS and DBS, the acceptance limit was met for 83.0% and 96.6% of the samples, respectively.
Conclusions
VAMS sampling can replace WB sampling for tacrolimus trough concentration monitoring, but VAMS sampling is currently inferior to DBS sampling, both regarding sample quality and agreement with WB tacrolimus concentrations.
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Affiliation(s)
- Herman Veenhof
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands
| | - Remco A. Koster
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands
- PRA Health Sciences, Bioanalytical Laboratory , Assen , The Netherlands
| | - Lenneke A.T. Junier
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands
| | - Stefan P. Berger
- University of Groningen , Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Stephan J.L. Bakker
- University of Groningen , Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen , Groningen , The Netherlands
| | - Daan J. Touw
- University of Groningen , Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , PO Box 30.001, 9700 RB Groningen , The Netherlands
- University of Groningen , Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen , Groningen , The Netherlands , Phone: +31 503614071, Fax: +31 503612417
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Geers LM, Cohen D, Wehkamp LM, van Hateren K, Koster RA, Fedorenko OY, Semke AV, Bokhan N, Ivanova SA, Kosterink JGW, Loonen AJM, Touw DJ. Dried Blood Spot Analysis for Therapeutic Drug Monitoring of Clozapine. J Clin Psychiatry 2019; 78:e1211-e1218. [PMID: 29068609 DOI: 10.4088/jcp.16m11164] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Schizophrenia is a psychiatric disorder that affects approximately 0.4%-1% of the population worldwide. Diagnosis of schizophrenia is based primarily on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Clozapine is an antipsychotic drug that is mainly used in the treatment of schizophrenia patients who are refractory or intolerant to at least 2 other antipsychotics. Due to the high variability in pharmacokinetics of clozapine, therapeutic drug monitoring (TDM) is highly recommended for clozapine therapy. OBJECTIVE To develop and clinically validate a novel sampling method using dried blood spot (DBS) to support TDM of clozapine and norclozapine. METHODS From June 2014 to September 2014, 15 schizophrenia patients (18-55 years) treated with clozapine were included. Plasma, DBS samples made from venous samples (VDBS), and finger prick DBS (DBS) samples were obtained before administration and 2, 4, 6, and 8 hours after clozapine intake. The study was repeated in 6 Russian patients for external validation. Passing-Bablok regression and Bland-Altman analysis were used to compare the DBS, VDBS, and plasma results for clozapine and norclozapine. RESULTS The DBS validation results showed good linearity over the concentration time curve measured for clozapine and norclozapine. The accuracy and between- and within-day precision variation values were within accepted ranges. Different blood spot volumes and hematocrit values had no significant influence on the results. The DBS samples were stable at 20°C and 37°C for 2 weeks and at -20°C for 2 years. The mean clozapine and norclozapine DBS/plasma ratios were, respectively, 0.80 (95% CI, 0.76 to 0.85) and 1.063 (95% CI, 1.027 to 1.099) in Dutch patients. The mean clozapine DBS/DPS ratio in Russian patients was 0.70 (95% CI, 0.64 to 0.76). CONCLUSION DBS analysis is a reliable tool for blood sampling and performing TDM of clozapine and norclozapine in daily practice and substantially extends the opportunities for TDM of clozapine.
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Affiliation(s)
- Lisanne M Geers
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dan Cohen
- Department of Community Psychiatry, FACT-team Heerhugowaard, Mental Health Organization North-Holland North, Heerhugowaard, The Netherlands
| | - Laura M Wehkamp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kai van Hateren
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remco A Koster
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Olga Yu Fedorenko
- Mental Health Research Institute, Tomsk, Russian Federation.,National Research Tomsk Polytechnic University, Tomsk, Russian Federation
| | | | - Nikolay Bokhan
- Mental Health Research Institute, Tomsk, Russian Federation
| | - Svetlana A Ivanova
- Mental Health Research Institute, Tomsk, Russian Federation.,National Research Tomsk Polytechnic University, Tomsk, Russian Federation
| | - Jos G W Kosterink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Anton J M Loonen
- Department of Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. .,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Pharmacokinetics, Toxicology and Targeting, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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6
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Veenhof H, Koster RA, Alffenaar JWC, van den Berg AP, de Groot MR, Verschuuren EA, Berger SP, Bakker SJ, Touw DJ. Clinical application of a dried blood spot assay for sirolimus and everolimus in transplant patients. ACTA ACUST UNITED AC 2019; 57:1854-1862. [DOI: 10.1515/cclm-2019-0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/08/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Monitoring of immunosuppressive drugs such as everolimus and sirolimus is important in allograft rejection prevention in transplant patients. Dried blood spots (DBS) sampling gives patients the opportunity to sample a drop of blood from a fingerprick at home, which can be sent to the laboratory by mail.
Methods
A total of 39 sirolimus and 44 everolimus paired fingerprick DBS and whole blood (WB) samples were obtained from 60 adult transplant patients for method comparison using Passing-Bablok regression. Bias was assessed using Bland-Altman. Two validation limits were pre-defined: limits of analytical acceptance were set at >67% of all paired samples within 20% of the mean of both samples and limits of clinical relevance were set in a multidisciplinary team at >80% of all paired samples within 15% of the mean of both samples.
Results
For both sirolimus and everolimus, Passing-Bablok regression showed no differences between WB and DBS with slopes of 0.86 (95% CI slope, 0.72–1.02) and 0.96 (95% CI 0.84–1.06), respectively. Only everolimus showed a significant constant bias of 4%. For both sirolimus and everolimus, limits of analytical acceptance were met (76.9% and 81.8%, respectively), but limits or clinical relevance were not met (77.3% and 61.5%, respectively).
Conclusions
Because pre-defined limits of clinical relevance were not met, this DBS sampling method for sirolimus and everolimus cannot replace WB sampling in our center at this time. However, if the clinical setting is compatible with less strict limits for clinical relevance, this DBS method is suitable for clinical application.
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Affiliation(s)
- Herman Veenhof
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Remco A. Koster
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
- PRA Health Sciences , Bioanalytical Laboratory , Assen , The Netherlands
| | - Jan-Willem C. Alffenaar
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Aad P. van den Berg
- Department of Gastroenterology and Hepatology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Marco R. de Groot
- Department of Hematology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Erik A.M. Verschuuren
- Department of Pulmonology and Tuberculosis , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Stefan P. Berger
- Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
- Department of Pharmacy, Section Pharmacokinetics, Toxicology and Targeting , University of Groningen , Groningen , The Netherlands , Phone: +31 503614071, Fax: +31 503612417
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ter Avest M, Veringa A, van Hateren K, Koster RA, Touw DJ, Alffenaar JW. Method for Therapeutic Drug Monitoring of Voriconazole and its Primary Metabolite Voriconazole-N-oxide in Human Serum using LC-MS/MS. J Appl Bioanal 2018. [DOI: 10.17145/jab.18.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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8
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Lambooy SPH, Bidadkosh A, Nakladal D, van Buiten A, Girgis RAT, van der Graaf AC, Wiedenmann TJ, Koster RA, Vogelaar P, Buikema H, Henning RH, Deelman LE. The Novel Compound Sul-121 Preserves Endothelial Function and Inhibits Progression of Kidney Damage in Type 2 Diabetes Mellitus in Mice. Sci Rep 2017; 7:11165. [PMID: 28894214 PMCID: PMC5593963 DOI: 10.1038/s41598-017-11582-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/25/2017] [Indexed: 11/17/2022] Open
Abstract
Diabetic nephropathy is still a common complication of type 2 diabetes mellitus (T2DM) and improvement of endothelial dysfunction (ED) and inhibition of reactive oxygen species (ROS) are considered important targets for new therapies. Recently, we developed a new class of compounds (Sul compounds) which inhibit mitochondrial ROS production. Here, we tested the therapeutic effects of Sul-121 on ED and kidney damage in experimental T2DM. Diabetic db/db and lean mice were implanted with osmotic pumps delivering Sul-121 (2.2 mg/kg/day) or vehicle from age 10 to 18 weeks. Albuminuria, blood pressure, endothelial mediated relaxation, renal histology, plasma creatinine, and H2O2 levels were assessed. Sul-121 prevented progression of albuminuria and attenuated kidney damage in db/db, as evidenced by lower glomerular fibronectin expression (~50%), decreased focal glomerular sclerosis score (~40%) and normalization of glomerular size and kidney weight. Further, Sul-121 restored endothelium mediated vasorelaxation through increased production of Nitric Oxide production and normalized plasma H2O2 levels. Sul-121 treatment in lean mice demonstrated no observable major side-effects, indicating that Sul-121 is well tolerated. Our data show that Sul-121 inhibits progression of diabetic kidney damage via a mechanism that involves restoration of endothelial function and attenuation of oxidative stress.
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Affiliation(s)
- S P H Lambooy
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Bidadkosh
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D Nakladal
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pharmacology & Toxicology, Comenius University, Bratislava, Slovakia
| | - A van Buiten
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A T Girgis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - T J Wiedenmann
- Department of Physiology, University of Heidelberg, Heidelberg, Germany
| | - R A Koster
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - H Buikema
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R H Henning
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L E Deelman
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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VanDerNagel JEL, Kiewik M, van Dijk M, Didden R, Korzilius HPLM, van der Palen J, Buitelaar JK, Uges DRA, Koster RA, de Jong CAJ. Substance use in individuals with mild to borderline intellectual disability: A comparison between self-report, collateral-report and biomarker analysis. Res Dev Disabil 2017; 63:151-159. [PMID: 27133469 DOI: 10.1016/j.ridd.2016.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND AIMS Individuals with mild or borderline intellectual disability (MBID) are at risk of substance use (SU). At present, it is unclear which strategy is the best for assessing SU in individuals with MBID. This study compares three strategies, namely self-report, collateral-report, and biomarker analysis. METHODS AND PROCEDURES In a sample of 112 participants with MBID from six Dutch facilities providing care to individuals with intellectual disabilities, willingness to participate, SU rates, and agreement between the three strategies were explored. The Substance use and misuse in Intellectual Disability - Questionnaire (SumID-Q; self-report) assesses lifetime use, use in the previous month, and recent use of tobacco, alcohol, cannabis, and stimulants. The Substance use and misuse in Intellectual Disability - Collateral-report questionnaire (SumID-CR; collateral-report) assesses staff members' report of participants' SU over the same reference periods as the SumID-Q. Biomarkers for SU, such as cotinine (metabolite of nicotine), ethanol, tetrahydrocannabinol (THC), and its metabolite THCCOOH, benzoylecgonine (metabolite of cocaine), and amphetamines were assessed in urine, hair, and sweat patches. RESULTS Willingness to provide biomarker samples was significantly lower compared to willingness to complete the SumID-Q (p<0.001). Most participants reported smoking, drinking alcohol, and using cannabis at least once in their lives, and about a fifth had ever used stimulants. Collateralreported lifetime use was significantly lower. However, self-reported past month and recent SU rates did not differ significantly from the rates from collateral-reports or biomarkers, with the exception of lower alcohol use rates found in biomarker analysis. The agreement between self-report and biomarker analysis was substantial (kappas 0.60-0.89), except for alcohol use (kappa 0.06). Disagreement between SumID-Q and biomarkers concerned mainly over-reporting of the SumID-Q. The agreement between SumID-CR and biomarker analysis was moderate to substantial (kappas 0.48 - 0.88), again with the exception of alcohol (kappa 0.02). CONCLUSIONS AND IMPLICATIONS In this study, the three strategies that were used to assess SU in individuals with MBID differed significantly in participation rates, but not in SU rates. Several explanations for the better-than-expected performance of self- and collateral-reports are presented. We conclude that for individuals with MBID, self-report combined with collateralreport can be used to assess current SU, and this combination may contribute to collaborative, early intervention efforts to reduce SU and its related harms in this vulnerable group.
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Affiliation(s)
- Joanneke E L VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands; Tactus Addiction Treatment, Raiffeisenstraat 75, 7514 AM Enschede, The Netherlands; Aveleijn, Grotestraat 260, 7622 GW Borne, The Netherlands.
| | - Marion Kiewik
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands; Aveleijn, Grotestraat 260, 7622 GW Borne, The Netherlands
| | - Marike van Dijk
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands; Tactus Addiction Treatment, Raiffeisenstraat 75, 7514 AM Enschede, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands; Trajectum, P.O. Box 40012, 8004 DA Zwolle, The Netherlands
| | - Hubert P L M Korzilius
- Institute for Management Research, Radboud University, Thomas van Aquinostraat 5, 6525 GD Nijmegen, The Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, Faculty of Behavioral Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; Medical School Twente, Medisch Spectrum Twente, Ariënsplein 1, 7511 JX Enschede, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Centre, P.O. Box 9101 (204), 6500HB Nijmegen, The Netherlands
| | - Donald R A Uges
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Clinical Pharmaceutical and Toxicological Laboratory, P.O. Box 30.001, 9700 RB Groningen, University of Groningen, The Netherlands
| | - Remco A Koster
- University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Clinical Pharmaceutical and Toxicological Laboratory, P.O. Box 30.001, 9700 RB Groningen, University of Groningen, The Netherlands
| | - Cor A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands; Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands
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Akkerman OW, van Hateren K, Koster RA, Luijckx GJR, van der Werf TS, Alffenaar JWC. Reply to Verhaeghe et al. Clin Infect Dis 2016; 63:146-7. [PMID: 27025830 DOI: 10.1093/cid/ciw165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Onno W Akkerman
- Tuberculosis Center Beatrixoord, Department of Pulmonary Diseases and Tuberculosis
| | | | | | | | - Tjip S van der Werf
- Department of Pulmonary Diseases and Tuberculosis Department of Internal Medicine, University of Groningen, University Medical Center Groningen, The Netherlands
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Koster RA, Botma R, Greijdanus B, Uges DR, Kosterink JG, Alffenaar JWC, Touw DJ. The influence of the dried blood spot drying time on the recoveries of six immunosuppressants. J Appl Bioanal 2015. [DOI: 10.17145/jab.15.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Koster RA, Vereecke HEM, Greijdanus B, Touw DJ, Struys MMRF, Alffenaar JWC. Analysis of remifentanil with liquid chromatography-tandem mass spectrometry and an extensive stability investigation in EDTA whole blood and acidified EDTA plasma. Anesth Analg 2015; 120:1235-41. [PMID: 25692453 DOI: 10.1213/ane.0000000000000643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Remifentanil is a μ-opioid receptor agonist that was developed as a synthetic opioid for use in anesthesia and intensive care medicine. Remifentanil is rapidly metabolized in both blood and tissues, which results in a very short duration of action. Even after blood sampling, remifentanil is unstable in whole blood and plasma through endogenous esterases and chemical hydrolysis. The instability of remifentanil in these matrices makes sample collection and processing a critical phase in the bioanalysis of remifentanil. METHODS We have developed a fast and simple sample preparation method using protein precipitation followed by liquid chromatography-tandem mass spectrometry analysis. To improve the stability of remifentanil, citric acid, ascorbic acid, and formic acid were investigated for acidification of EDTA plasma. The stability of remifentanil was investigated in stock solution, EDTA whole blood, EDTA plasma, and acidified EDTA plasma at ambient temperature, 4 °C, 0 °C, and at -20 °C. RESULTS The analytical method was fully validated based on the Food and Drug Administration guidelines for bioanalytical method validation with a large linear range of 0.20 to 250 ng/mL remifentanil in EDTA plasma acidified with formic acid. The stability results of remifentanil in EDTA tubes, containing whole blood placed in ice water, showed a decrease of approximately 2% in 2 hours. EDTA plasma acidified with citric acid, formic acid, and ascorbic acid showed 0.5%, 4.2%, and 7.2% remifentanil degradation, respectively, after 19 hours at ambient temperature. Formic acid was chosen because of its volatility and thus liquid chromatography-tandem mass spectrometry compatibility. The use of formic acid added to EDTA plasma improved the stability of remifentanil, which was stable for 2 days at ambient temperature, 14 days at 4 °C, and 103 days at -20 °C. CONCLUSIONS The analytical method we developed uses a simple protein precipitation and maximal throughput by a 2-point calibration curve and short run times of 2.6 minutes. Best sample stability is obtained by placing tubes containing EDTA whole blood in ice water directly after sampling, followed by centrifugation and transfer of the EDTA plasma to tubes with formic acid. The stability of remifentanil in EDTA plasma was significantly improved by the addition of 1.5 μL formic acid per milliliter of EDTA plasma. This analytical method and sample pretreatment are suitable for remifentanil pharmacokinetic studies.
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Affiliation(s)
- Remco A Koster
- From the *Department of Clinical Pharmacy and Pharmacology, Laboratory for Clinical and Forensic Toxicology and Drugs Analysis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and †Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Koster RA, Alffenaar JWC, Greijdanus B, VanDernagel JEL, Uges DRA. Fast and highly selective LC-MS/MS screening for THC and 16 other abused drugs and metabolites in human hair to monitor patients for drug abuse. Ther Drug Monit 2015; 36:234-43. [PMID: 24071815 DOI: 10.1097/ftd.0b013e3182a377e8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To facilitate the monitoring of drug abuse by patients, a method was developed and validated for the analysis of amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, methylenedioxyamphetamine, methylenedioxyethylamphetamine, methylphenidate, cocaine, benzoylecgonine, morphine, codeine, heroin, 6-monoacteylmorphine, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), delta-9-tetrahydrocannabinol (THC), nicotine, and cotinine in human hair. METHODS The hair preparation method contains a 3-step wash procedure with dichloromethane followed by a simultaneous hair pulverization and extraction procedure with disposable metal balls. The developed liquid chromatography tandem mass spectrometry method uses a single injection to detect and confirm all 17 abused drugs, including THC, within 4.8 minutes. RESULTS Nicotine was validated with a linear range of 800-25,000 pg/mg hair, and all other substances were validated with a linear range of 30.0-2500 pg/mg hair. For inaccuracy and imprecision, the overall bias did not exceed -8.2% and the overall coefficient of variation did not exceed 17.7%. Autosampler stability was proven for 48 hours at 10°C for all substances. Analytical cutoff concentrations were defined for each substance at the lowest validated inaccuracy and imprecision concentration with a bias and coefficient of variation within 15% and qualifier/quantifier ratios within 20% of the set ratio. The analytical cutoff concentrations were 200 pg/mg for codeine and 80.0 pg/mg for 6-MAM, heroin, EDDP, and THC. The analytical cutoff concentration for nicotine was 800 pg/mg and for all other validated substances 30.0 pg/mg. This method was successfully applied to analyze hair samples from patients who were monitored for drug abuse. Hair samples of 47 subjects (segmented into 129 samples) showed 3,4-methylenedioxymethamphetamine, methylphenidate, cocaine, benzoylecgonine, codeine, methadone, EDDP, THC, nicotine, and cotinine above the analytical cutoff. CONCLUSIONS The method was fully validated, including the validation of the qualifier/quantifier ratios. The analysis of real hair samples proved the efficacy of the developed method for monitoring drug abuse. The results obtained by this method provide the physician or health-care professional with extensive information about actual drug abuse or relapse and can be used for patient-specific therapy.
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Affiliation(s)
- Remco A Koster
- *Laboratory for Clinical and Forensic Toxicology and Drugs Analysis, Department of Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen; †SumID-Project, Zorgontwikkeling, Tactus Addiction Medicine, Deventer; and ‡ACSW-Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands
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Koster RA, Greijdanus B, Alffenaar JWC, Touw DJ. Dried blood spot analysis of creatinine with LC-MS/MS in addition to immunosuppressants analysis. Anal Bioanal Chem 2014; 407:1585-94. [DOI: 10.1007/s00216-014-8415-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 11/25/2022]
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