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Barber J, Al-Majdoub ZM, Couto N, Howard M, Elmorsi Y, Scotcher D, Alizai N, de Wildt S, Stader F, Sepp A, Rostami-Hodjegan A, Achour B. Toward systems-informed models for biologics disposition: covariates of the abundance of the neonatal Fc Receptor (FcRn) in human tissues and implications for pharmacokinetic modelling. Eur J Pharm Sci 2023; 182:106375. [PMID: 36626943 DOI: 10.1016/j.ejps.2023.106375] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Biologics are a fast-growing therapeutic class, with intertwined pharmacokinetics and pharmacodynamics, affected by the abundance and function of the FcRn receptor. While many investigators assume adequacy of classical models, such as allometry, for pharmacokinetic characterization of biologics, advocates of physiologically-based pharmacokinetics (PBPK) propose consideration of known systems parameters that affect the fate of biologics to enable a priori predictions, which go beyond allometry. The aim of this study was to deploy a systems-informed modelling approach to predict the disposition of Fc-containing biologics. We used global proteomics to quantify the FcRn receptor [p51 and β2-microglobulin (B2M) subunits] in 167 samples of human tissue (liver, intestine, kidney and skin) and assessed covariates of its expression. FcRn p51 subunit was highest in liver relative to other tissues, and B2M was 1-2 orders of magnitude more abundant than FcRn p51 across all sets. There were no sex-related differences, while higher expression was confirmed in neonate liver compared with adult liver. Trends of expression in liver and kidney indicated a moderate effect of body mass index, which should be confirmed in a larger sample size. Expression of FcRn p51 subunit was approximately 2-fold lower in histologically normal liver tissue adjacent to cancer compared with healthy liver. FcRn mRNA in plasma-derived exosomes correlated moderately with protein abundance in matching liver tissue, opening the possibility of use as a potential clinical tool. Predicted effects of trends in FcRn abundance in healthy and disease (cancer and psoriasis) populations using trastuzumab and efalizumab PBPK models were in line with clinical observations, and global sensitivity analysis revealed endogenous IgG plasma concentration and tissue FcRn abundance as key systems parameters influencing exposure to Fc-conjugated biologics.
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Affiliation(s)
- Jill Barber
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom
| | - Zubida M Al-Majdoub
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom
| | - Narciso Couto
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom
| | - Martyn Howard
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom
| | - Yasmine Elmorsi
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom
| | - Daniel Scotcher
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom
| | | | - Saskia de Wildt
- Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Felix Stader
- Certara UK Ltd. (Simcyp Division), Sheffield, United Kingdom
| | - Armin Sepp
- Certara UK Ltd. (Simcyp Division), Sheffield, United Kingdom
| | - Amin Rostami-Hodjegan
- Centre for Applied Pharmacokinetic Research, the University of Manchester, Manchester, United Kingdom; Certara UK Ltd. (Simcyp Division), Sheffield, United Kingdom
| | - Brahim Achour
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, the University of Rhode Island, 495A Avedisian Hall, 7 Greenhouse Road, Kingston, RI 02881, United States.
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2
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Eymael J, van den Broek M, Miesen L, Monge VV, van den Berge BT, Mooren F, Velez VL, Dijkstra J, Hermsen M, Bándi P, Vermeulen M, de Wildt S, Willemsen B, Florquin S, Wetzels R, Steenbergen E, Kramann R, Moeller M, Schreuder MF, Wetzels JF, van der Vlag J, Jansen J, Smeets B. Human scattered tubular cells represent a heterogeneous population of glycolytic dedifferentiated proximal tubule cells. J Pathol 2023; 259:149-162. [PMID: 36373978 PMCID: PMC10107692 DOI: 10.1002/path.6029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/19/2022] [Revised: 09/22/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Scattered tubular cells (STCs) are a phenotypically distinct cell population in the proximal tubule that increase in number after acute kidney injury. We aimed to characterize the human STC population. Three-dimensional human tissue analysis revealed that STCs are preferentially located within inner bends of the tubule and are barely present in young kidney tissue (<2 years), and their number increases with age. Increased STC numbers were associated with acute tubular injury (kidney injury molecule 1) and interstitial fibrosis (alpha smooth muscle actin). Isolated CD13+ CD24- CD133- proximal tubule epithelial cells (PTECs) and CD13+ CD24+ and CD13+ CD133+ STCs were analyzed using RNA sequencing. Transcriptome analysis revealed an upregulation of nuclear factor κB, tumor necrosis factor alpha, and inflammatory pathways in STCs, whereas metabolism, especially the tricarboxylic acid cycle and oxidative phosphorylation, was downregulated, without showing signs of cellular senescence. Using immunostaining and a publicly available single-cell sequencing database of human kidneys, we demonstrate that STCs represent a heterogeneous population in a transient state. In conclusion, STCs are dedifferentiated PTECs showing a metabolic shift toward glycolysis, which could facilitate cellular survival after kidney injury. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Jennifer Eymael
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martijn van den Broek
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Laura Miesen
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Valerie Villacorta Monge
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bartholomeus T van den Berge
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fieke Mooren
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vicky Luna Velez
- Department of Molecular Biology, Radboud Institute for Molecular Life Science, Nijmegen, The Netherlands
| | - Jelmer Dijkstra
- Department of Molecular Biology, Radboud Institute for Molecular Life Science, Nijmegen, The Netherlands
| | - Meyke Hermsen
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Péter Bándi
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Vermeulen
- Department of Molecular Biology, Radboud Institute for Molecular Life Science, Nijmegen, The Netherlands
| | - Saskia de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Science, Nijmegen, The Netherlands
| | - Brigith Willemsen
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Infection and Immunology, Amsterdam, The Netherlands
| | - Roy Wetzels
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Steenbergen
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rafael Kramann
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany.,Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany.,Department of Internal Medicine, Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marcus Moeller
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jack Fm Wetzels
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan van der Vlag
- Department of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jitske Jansen
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.,Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Bart Smeets
- Department of Pathology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Smeets N, IntHout J, van der Burgh M, Schwartz G, Schreuder M, de Wildt S. Maturation of Glomerular Filtration Rate in Term-Born Neonates: An Individual Participant Data Meta-Analysis. J Am Soc Nephrol 2022; 33:1277-1292. [PMID: 35474022 PMCID: PMC9257816 DOI: 10.1681/asn.2021101326] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/28/2022] [Indexed: 11/03/2022] Open
Abstract
Background: The evidence from individual studies to support the maturational pattern of glomerular filtration rate (GFR) in healthy term-born neonates is inconclusive. We performed an individual participant data (IPD) meta-analysis of reported measured GFR (mGFR) data aimed to establish neonatal GFR reference values. Furthermore, we aimed to optimise neonatal creatinine-based GFR estimations Methods: We identified studies reporting mGFR measured by exogenous markers or creatinine clearance (CrCL) in healthy term-born neonates. The relationship between postnatal age and clearance was investigated using cubic splines with generalized additive linear mixed models. From our reference values, we estimated an updated coefficient for the Schwartz equation (eGFR(ml/min/1.73m2)=(k*height (cm))/serum creatinine(mg/dl)). Results: Forty-eight out of 1521 screened articles reported mGFR in healthy term-born neonates, and 978 mGFR values from 881 neonates were analysed. IPD were available for 367 neonates and the other 514 neonates were represented by 41 aggregated data points as means/medians per group. GFR doubled in the first five days after birth from 19.6 (95%CI 14.7;24.6) ml/min/1.73m2 to 40.6 (95%CI 36.7;44.5) ml/min/1.73m2, then more gradually increased to 59.4 (95%CI 45.9;72.9) ml/min/1.73m2 by four weeks of age. A coefficient of 0.31 to estimate GFR best fitted the data. Conclusions: These reference values for healthy term-born neonates show a biphasic increase in GFR with the largest increase between days 1 and 5. Together with the re-examined Schwartz equation, this can help identify altered GFR in term-born neonates. To enable widespread implementation of our proposed eGFR equation, validation in a large cohort of neonates is required.
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Affiliation(s)
- Nori Smeets
- N Smeets, Department of Pharmacology and Toxicology, Radboudumc Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Joanna IntHout
- J IntHout, Department for Health Evidence, Section Biostatistics, Radboudumc, Nijmegen, Netherlands
| | - Maurice van der Burgh
- M van der Burgh, Department of Pharmacology and Toxicology, Radboudumc Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - George Schwartz
- G Schwartz, Department of Pediatrics, Pediatric Nephrology, University of Rochester Medical Center, Rochester, United States
| | - Michiel Schreuder
- M Schreuder, Department of Pediatrics, division of Pediatric Nephrology, Radboudumc, Nijmegen, Netherlands
| | - Saskia de Wildt
- S de Wildt, Department of Pharmacology and Toxicology, Radboudumc Radboud Institute for Health Sciences, Nijmegen, Netherlands
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Toma M, Felisi M, Bonifazi D, Bonifazi F, Giannuzzi V, Reggiardo G, de Wildt S, Ceci A. Paediatric Medicines in Europe: The Paediatric Regulation-Is It Time for Reform? Front Med (Lausanne) 2021; 8:593281. [PMID: 33604345 PMCID: PMC7884470 DOI: 10.3389/fmed.2021.593281] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/12/2021] [Indexed: 02/03/2023] Open
Abstract
Objectives: In this paper, we investigated the effects of the European Paediatric Regulation (EC) N° 1901/2006 with respect to satisfying the paediatric therapeutic needs, assessed in terms of the increased number of paediatric medicinal products, new therapeutic indications in specific high-need conditions (neonates, oncology, rare disease, etc.) and increased number of paediatric clinical studies supporting the marketing authorisation. Methods: We analysed the paediatric medicinal products approved by the European Medicines Agency in the period January 2007-December 2019, by collecting the following data: year of approval, active substance, legal basis for the marketing authorisation, type of medicinal product (i.e., chemical, biological, or ATMP), orphan drug status, paediatric indication, Anatomical Therapeutic Chemical code (first-level), number and type of paediatric studies. Data were compared with similar data collected in the period 1996–2006. Results: In the period January 1996–December 2019, in a total of 1,190 medicinal products and 843 active substances, 34 and 38%, respectively, were paediatric. In the two periods, before and after the Paediatric Regulation implementation, the paediatric/total medicinal products ratio was constant while the paediatric/total active substances ratio decreased. Moreover, excluding generics and biosimilars, a total of 106 and 175 paediatric medicines were granted a new paediatric indication, dosage or age group in the two periods; out of 175, 128 paediatric medicines had an approved Paediatric Investigational Plan. The remaining 47 were approved without an approved Paediatric Investigational Plan, following the provisions of Directive 2001/83/EC and repurposing an off-patent drug. The analysis of the clinical studies revealed that drugs with a Paediatric Investigational Plan were supported by 3.5 studies/drug while drugs without a Paediatric Investigational Plan were supported by only 1.6 studies/drug. Discussion: This report confirms that the expectations of the European Paediatric Regulation (EC) N° 1901/2006 have been mainly satisfied. However, the reasons for the limited development of paediatric medicines in Europe, should be further discussed, taking advantage of recent initiatives in the regulatory field, such as the Action Plan on Paediatrics, and the open consultation on EU Pharmaceutical Strategy.
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Affiliation(s)
- Maddalena Toma
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
| | | | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari, Italy
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
| | - Viviana Giannuzzi
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
| | | | - Saskia de Wildt
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica "Gianni Benzi" Onlus, Bari, Italy
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5
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Turner MA, Cheng K, de Wildt S, Hildebrand H, Attar S, Rossi P, Bonifazi D, Ceci A, Claverol J, Nafria B, Giaquinto C. European research networks to facilitate drug research in children. Br J Clin Pharmacol 2020; 88:4258-4266. [PMID: 32893382 PMCID: PMC9546307 DOI: 10.1111/bcp.14545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 01/04/2023] Open
Abstract
Paediatric drug development faces several barriers. These include fragmentation of stakeholders and inconsistent processes during the conduct of research. This review summarises recent efforts to overcome these barriers in Europe. Two exemplar initiatives are described. The European Paediatric Translational Research Infrastructure facilitates preclinical research and other work that underpins clinical trials. conect4children facilitates the design and implementation of clinical trials. Both these initiatives listen to the voices of children and their advocates. Coordination of research needs specific effort that supplements work on science, resources and the policy context.
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Affiliation(s)
- Mark A Turner
- Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Katharine Cheng
- Child Health Innovation Leadership Department (CHILD), Johnson and Johnson, High Wycombe, UK
| | - Saskia de Wildt
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heidrun Hildebrand
- Pediatric Development, Research & Development, Pharmaceuticals, Bayer AG, Berlin, Germany
| | - Sabah Attar
- Institute of Lifecourse and Medical Sciences, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Paolo Rossi
- Academic Department of Pediatrics (DPUO), Unit of Perinatal infection and congenital infectious diseases, Bambino Gesu Children's Hospital-University of Rome Tor Vergata, Rome, Italy
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Bari, Italy
| | - Joana Claverol
- Institut de Recerca Sant Joan de Deu, Sant Joan de Deu Research Foundation, Barcelona, Spain
| | - Begonya Nafria
- Institut de Recerca Sant Joan de Deu, Sant Joan de Deu Research Foundation, Barcelona, Spain
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Woman's and Child's Health, University of Padua, Padua, Italy
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Suessenbach FK, Makowski N, Feickert M, Gangnus T, Tins J, Burckhardt BB, Läer S, Breitkreutz J, Klingmann I, Lagler F, de Hoon J, Dalinghaus M, Bajcetic M, de Wildt S, Clarke AK, Breur J, Male C, Ablonczy L, Mir T, Vukomanovic V, Dukic M, Jovanovic I, Burckhardt BB, Cawello W, Kleine K, Moder A, Obarcanin E, Wagner P, Walsh J, van Hecken A, Spatenkova L, Ali M, Božić B, Burdman MBI, Ciplea A, Faisal M, Farahani S, Feickert M, Gangnus T, Lazic M, Makowski N, Suessenbach F, van der Meulen M, Popović S, Parezanović M, Smeets N, Swoboda V, Bojanin D, Đorđević S, Dragić J, Holle AK, Jovičić B, Košutić J, Kozomara G, Majid H, Mitrović J, Ninić S, Parezanovic M, Parezanovic V, Pavlović A, Prijić S, Rebić B, Stefanović I, Tordas D, Vulićević I, Bartels A, Čeko A, Herborts M, Hennink A, Kosanović B, Kostic S, Isailović L, Maksimovic J, Manai B, Martinović N, Máté G, Perišić M, Reljić J, Salamomovic RPM, Schlesner C, Tins J, Wissmann E. A quality control system for ligand-binding assay of plasma renin activity: Proof-of-concept within a pharmacodynamic study. J Pharm Biomed Anal 2020; 181:113090. [DOI: 10.1016/j.jpba.2019.113090] [Citation(s) in RCA: 2] [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] [Received: 10/28/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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7
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de Wildt S. S10.1 - Ontogeny of human membrane transporters: From data to application. Drug Metab Pharmacokinet 2020. [DOI: 10.1016/j.dmpk.2020.04.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Völler S, Flint RB, Beggah F, Reiss I, Andriessen P, Zimmermann LJI, van den Anker JN, Liem KD, Koch BCP, de Wildt S, Knibbe CAJ, Simons SHP. Recently Registered Midazolam Doses for Preterm Neonates Do Not Lead to Equal Exposure: A Population Pharmacokinetic Model. J Clin Pharmacol 2019; 59:1300-1308. [PMID: 31093992 PMCID: PMC6767398 DOI: 10.1002/jcph.1429] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/04/2019] [Indexed: 11/11/2022]
Abstract
Although midazolam is a frequently used sedative in neonatal intensive care units, its use in preterm neonates has been off-label. Recently, a new dosing advice for midazolam for sedation on intensive care units has been included in the label (0.03 mg/[kg·h] for preterm neonates <32 weeks and 0.06 mg/[kg·h] for neonates >32 weeks). Concentration-time data of a prospective multicenter study (29 patients, median gestational age 26.7 [range 24.0-31.1 weeks]) were combined with previously published data (26 patients, median gestational age 28.1 [range 26.3-33.6 weeks]), and a population pharmacokinetic model describing the maturation of midazolam pharmacokinetics was developed in NONMEM 7.3. Clearance was 73.7 mL/h for a neonate weighing 1.1 kg and changed nonlinearly with body weight (exponent 1.69). Volume of distribution increased linearly with body weight and was 1.03 L for a neonate weighing 1.1 kg. Simulations of the newly registered dosing show considerable differences in steady-state concentrations in preterm neonates. To reach similar steady-state concentrations of 400 µg/mL (±100 µg/mL), a dose of 0.03 mg/(kg·h) is adequate for neonates ≥1 kg and ≤2 kg but would have to be reduced to 0.02 mg/(kg·h) (-33%) in neonates <1 kg and increased to 0.04 mg/(kg·h) (+33%) in neonates weighing >2 kg and ≤2.5 kg. The impact of the observed differences in exposure is difficult to assess because no target concentrations have yet been defined for midazolam, but the current analysis shows that one should be cautious in giving dosage advice based on historical data with a lack of reliable pharmacokinetic and effect data.
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Affiliation(s)
- Swantje Völler
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert B Flint
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fouzi Beggah
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.,Université de Montpellier, Montpellier, France
| | - Irwin Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Andriessen
- Department of Pediatrics, Division of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics, Maastricht University Medical Center, School of Oncology and Developmental Biology, School of Mental Health and Neuroscience, Maastricht, The Netherlands
| | - John N van den Anker
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA.,Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Kian D Liem
- Department of Pediatrics, Division of Neonatology, Radboud, University Medical Center, Nijmegen, The Netherlands
| | - Birgit C P Koch
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Saskia 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 Medical Center, Nijmegen, The Netherlands
| | - Catherijne A J Knibbe
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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9
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Lepola P, Needham A, Mendum J, Sallabank P, Neubauer D, de Wildt S. Informed consent for paediatric clinical trials in Europe. Arch Dis Child 2016; 101:1017-1025. [PMID: 27226526 PMCID: PMC5136704 DOI: 10.1136/archdischild-2015-310001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Paediatric clinical trials are often conducted as multinational trials. Informed consent or assent is part of the ethics committee approval for clinical trials. The consent requirements vary between countries due to national laws and regulations, which are not harmonised in Europe. These discrepancies can present challenges for paediatric clinical trials. The aim of this study was to assemble these consent and assent requirements across the European Economic Area. The collated national requirements have not been publicly available before, despite a real need for this data. METHODS National consent and assent requirements for paediatric clinical trials were analysed and collated for 25 European Union Member States and 2 European Free Trade Association countries until the end of 2014. The data were retrieved from existing databases and through communication with the competent authorities and selected ethics committees. Results from a literature search for international or national guidelines, declarations and conventions and academic societies' publications served as comparison material. RESULTS Consent and assent requirements are heterogeneous across these countries. We compiled our findings in 'The Informed Consent and Assent Tool Kit', a table including 27 national consent and assent requirements listed by individual country. CONCLUSIONS Wide variation in paediatric consents and assents presents challenges for multinational paediatric trials in Europe. The toolkit is available for all those involved in paediatric clinical trials and ethics committees, providing a new platform for proactive feedback on informed consent requirements, and may finally lead to a needed harmonisation process, including uniform standards accepted across Europe.
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Affiliation(s)
- Pirkko Lepola
- Finnish Investigators Network for Pediatric Medicines, Clinical Research Institute Helsinki University Central Hospital Ltd,Helsinki, Finland,Tampere Center for Child Health Research, 33014 University of Tampere, Tampere, Finland
| | - Allison Needham
- The Hospital for Sick Children Research Institute, Toronto, Canada
| | | | | | - David Neubauer
- Department of Child, Adolescent and Developmental Neurology, University Children's Hospital/University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Saskia de Wildt
- Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands
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Hazendonk H, Fijnvandraat K, Lock J, Driessens M, van der Meer F, Meijer K, Kruip M, Gorkom BLV, Peters M, de Wildt S, Leebeek F, Cnossen M, Mathôt R. A population pharmacokinetic model for perioperative dosing of factor VIII in hemophilia A patients. Haematologica 2016; 101:1159-1169. [PMID: 27390359 DOI: 10.3324/haematol.2015.136275] [Citation(s) in RCA: 35] [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] [Received: 09/06/2015] [Accepted: 07/01/2016] [Indexed: 12/31/2022] Open
Abstract
The role of pharmacokinetic-guided dosing of factor concentrates in hemophilia is currently a subject of debate and focuses on long-term prophylactic treatment. Few data are available on its impact in the perioperative period. In this study, a population pharmacokinetic model for currently registered factor VIII concentrates was developed for severe and moderate adult and pediatric hemophilia A patients (FVIII levels <0.05 IUmL-1) undergoing elective, minor or major surgery. Retrospective data were collected on FVIII treatment, including timing and dosing, time point of FVIII sampling and all FVIII plasma concentrations achieved (trough, peak and steady state), brand of concentrate, as well as patients' and surgical characteristics. Population pharmacokinetic modeling was performed using non-linear mixed-effects modeling. Population pharmacokinetic parameters were estimated in 75 adults undergoing 140 surgeries (median age: 48 years; median weight: 80 kg) and 44 children undergoing 58 surgeries (median age: 4.3 years; median weight: 18.5 kg). Pharmacokinetic profiles were best described by a two-compartment model. Typical values for clearance, intercompartment clearance, central and peripheral volume were 0.15 L/h/68 kg, 0.16 L/h/68 kg, 2.81 L/68 kg and 1.90 L/68 kg. Interpatient variability in clearance and central volume was 37% and 27%. Clearance decreased with increasing age (P<0.01) and increased in cases with blood group O (26%; P<0.01). In addition, a minor decrease in clearance was observed when a major surgical procedure was performed (7%; P<0.01). The developed population model describes the perioperative pharmacokinetics of various FVIII concentrates, allowing individualization of perioperative FVIII therapy for severe and moderate hemophilia A patients by Bayesian adaptive dosing.
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Affiliation(s)
- Hendrika Hazendonk
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam
| | | | - Janske Lock
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam
| | | | - Felix van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center
| | - Karina Meijer
- University of Groningen, Department of Hematology, University Medical Center Groningen
| | - Marieke Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam
| | - Britta Laros-van Gorkom
- Department of Hematology, Radboud university medical center, Sophia Children's Hospital Rotterdam
| | - Marjolein Peters
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam
| | - Saskia de Wildt
- Intensive Care and Department of Pediatric Intensive Care, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam Department of Pharmacology, Radboud university medical center, The Netherlands
| | - Frank Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam
| | - Marjon Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center - Sophia Children's Hospital Rotterdam
| | - Ron Mathôt
- Hospital Pharmacy-Clinical Pharmacology, Academic Medical Center Amsterdam, The Netherlands
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Kapitein B, van Saet AW, Golab HD, de Hoog M, de Wildt S, Tibboel D, Bogers AJJC. Does pharmacotherapy influence the inflammatory responses during cardiopulmonary bypass in children? J Cardiovasc Pharmacol 2015; 64:191-7. [PMID: 24949583 DOI: 10.1097/fjc.0000000000000098] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiopulmonary bypass (CPB) induces a systemic inflammatory response syndrome (SIRS) by factors such as contact of the blood with the foreign surface of the extracorporeal circuit, hypothermia, reduction of pulmonary blood flow during CPB and endotoxemia. SIRS is maintained in the postoperative phase, co-occurring with a counter anti-inflammatory response syndrome. Research on the effects of drugs administered before the surgery, especially in the induction phase of anesthesia, as well as drugs used during extracorporeal circulation, has revealed that they greatly influence these postoperative inflammatory responses. A better understanding of these processes may not only improve postoperative recovery but also enable tailor-made pharmacotherapy, with both health and economic benefits. In this review, we describe the pathophysiology of SIRS and counter anti-inflammatory response syndrome in the light of CPB in children and the influence of drugs used on these syndromes.
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Affiliation(s)
- Berber Kapitein
- *Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; †Department of Anesthesiology, Intensive Care Unit, Erasmus MC, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands; and ‡Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, the Netherlands
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