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Yang H, Chu L, Wu Y, Wang W, Yang J, Zhang Q, Qiao S, Li X, Shen Z, Zhou Y, Liu S, Deng H. LC-MS/MS Quantification of Nevirapine and Its Metabolites in Hair for Assessing Long-Term Adherence. Molecules 2020; 25:molecules25235692. [PMID: 33276689 PMCID: PMC7730356 DOI: 10.3390/molecules25235692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023] Open
Abstract
The adherence assessment based on the combination of nevirapine (NVP) and its two metabolites (2-hydroxynevirapine and 3-hydroxynevirapine) would more comprehensively and accurately reflect long-term adherence than that of a single prototype. This study aimed to develop a specific, sensitive and selective method for simultaneous detection of the three compounds in hair and explore whether there was consistency among the three compounds in assessing long-term adherence. Furthermore, 75 HIV-positive patients who were taking the NVP drug were randomly recruited and divided into two groups (high-and low-adherence group). All participants self-reported their days of oral drug administration per month and provided their hair strands closest to the scalp at the region of posterior vertex. The concentrations of three compounds in the hair were determined using a developed LC-MS/MS method in multiple reaction monitoring. This method showed good performances in limit of quantification and accuracy with the recoveries from 85 to 115% and in precision with the intra-day and inter-day coefficients of variation within 15% for the three compounds. The population analysis revealed that patients with high-adherence showed significantly higher concentrations than those with low-adherence for all three compounds. There were significantly moderate correlations of nevirapine with 2-hydroxynevirapine and 3-hydroxynevirapin and high correlation between 2-hydroxynevirapine and 3-hydroxynevirapin. The two NVP’s metabolites showed high consistency with NVP in evaluating long-term adherence.
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Affiliation(s)
- Haoran Yang
- Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing 210096, China; (H.Y.); (L.C.); (Y.W.); (W.W.); (J.Y.)
- Department of Brain and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
- Institute of Child Development and Education, Research Center of Learning Science, Southeast University, Nanjing 210096, China
| | - Liuxi Chu
- Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing 210096, China; (H.Y.); (L.C.); (Y.W.); (W.W.); (J.Y.)
- Department of Brain and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
- Institute of Child Development and Education, Research Center of Learning Science, Southeast University, Nanjing 210096, China
| | - Yan Wu
- Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing 210096, China; (H.Y.); (L.C.); (Y.W.); (W.W.); (J.Y.)
- Department of Brain and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
- Institute of Child Development and Education, Research Center of Learning Science, Southeast University, Nanjing 210096, China
| | - Wei Wang
- Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing 210096, China; (H.Y.); (L.C.); (Y.W.); (W.W.); (J.Y.)
- Department of Brain and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
- Institute of Child Development and Education, Research Center of Learning Science, Southeast University, Nanjing 210096, China
| | - Jin Yang
- Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing 210096, China; (H.Y.); (L.C.); (Y.W.); (W.W.); (J.Y.)
- Institute of Child Development and Education, Research Center of Learning Science, Southeast University, Nanjing 210096, China
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Quan Zhang
- Department of Health Promotion, Education and Behavior, South Carolina Smart State Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC 29208, USA; (Q.Z.); (S.Q.); (X.L.)
- Institute of Applied Psychology and School of Public Administration, Hohai University, Nanjing 211100, China
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, South Carolina Smart State Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC 29208, USA; (Q.Z.); (S.Q.); (X.L.)
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, South Carolina Smart State Center for Healthcare Quality (CHQ), University of South Carolina, Columbia, SC 29208, USA; (Q.Z.); (S.Q.); (X.L.)
| | - Zhiyong Shen
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China; (Z.S.); (Y.Z.); (S.L.)
| | - Yuejiao Zhou
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China; (Z.S.); (Y.Z.); (S.L.)
| | - Shuaifeng Liu
- Guangxi Center for Disease Control and Prevention, Nanning 530028, China; (Z.S.); (Y.Z.); (S.L.)
| | - Huihua Deng
- Key Laboratory of Child Development and Learning Science, Ministry of Education, Southeast University, Nanjing 210096, China; (H.Y.); (L.C.); (Y.W.); (W.W.); (J.Y.)
- Department of Brain and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China
- Institute of Child Development and Education, Research Center of Learning Science, Southeast University, Nanjing 210096, China
- Correspondence: ; Tel.: +86-25-8379-5664; Fax: +86-25-8379-3779
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Charbe NB, Zacconi FC, Amnerkar N, Ramesh B, Tambuwala MM, Clementi E. Bio-analytical Assay Methods used in Therapeutic Drug Monitoring of Antiretroviral Drugs-A Review. CURRENT DRUG THERAPY 2019. [DOI: 10.2174/1574885514666181217125550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Several clinical trials, as well as observational statistics, have exhibited that the advantages of antiretroviral [ARV] treatment for humans with Human Immunodeficiency Virus / Acquired Immune Deficiency Syndrome HIV/AIDS exceed their risks. Therapeutic drug monitoring [TDM] plays a key role in optimization of ARV therapy. Determination of ARV’s in plasma, blood cells, and other biological matrices frequently requires separation techniques capable of high effectiveness, specific selectivity and high sensitivity. High-performance liquid chromatography [HPLC] coupled with ultraviolet [UV], Photodiode array detectors [PDA], Mass spectrophotometer [MS] detectors etc. are the important quantitative techniques used for the estimation of pharmaceuticals in biological samples. </P><P> Objective: This review article is aimed to give an extensive outline of different bio-analytical techniques which have been reported for direct quantitation of ARV’s. This article aimed to establish an efficient role played by the TDM in the optimum therapeutic outcome of the ARV treatment. It also focused on establishing the prominent role played by the separation techniques like HPLC and UPLC along with the detectors like UV and Mass in TDM. </P><P> Methods: TDM is based on the principle that for certain drugs, a close relationship exists between the plasma level of the drug and its clinical effect. TDM is of no value if the relationship does not exist. The analytical methodology employed in TDM should: 1) distinguish similar compounds; 2) be sensitive and precise and 3) is easy to use. </P><P> Results: This review highlights the advancement of the chromatographic techniques beginning from the HPLC-UV to the more advanced technique like UPLC-MS/MS. TDM is essential to ensure adherence, observe viral resistance and to personalize ARV dose regimens. It is observed that the analytical methods like immunoassays and liquid chromatography with detectors like UV, PDA, Florescent, MS, MS/MS and Ultra performance liquid chromatography (UPLC)-MS/MS have immensely contributed to the clinical outcome of the ARV therapy. Assay methods are not only helping physicians in limiting the side effects and drug interactions but also assisting in monitoring patient’s compliance. </P><P> Conclusion: The present review revealed that HPLC has been the most widely used system irrespective of the availability of more sensitive chromatographic technique like UPLC.
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Affiliation(s)
- Nitin B. Charbe
- Departamento de Quimica Organica, Facultad de Quimica y de Farmacia, Pontificia Universidad Catolica de Chile, Av. Vicuna McKenna 4860, Macul, Santiago 7820436, Chile
| | - Flavia C. Zacconi
- Departamento de Quimica Organica, Facultad de Quimica y de Farmacia, Pontificia Universidad Catolica de Chile, Av. Vicuna McKenna 4860, Macul, Santiago 7820436, Chile
| | - Nikhil Amnerkar
- Adv V. R. Manohar Institute of Diploma in Pharmacy, Wanadongri, Hingna Road, Nagpur, Maharashtra 441110, India
| | - B. Ramesh
- Sri Adichunchunagiri University, Sri Adichunchunagiri College of Pharmacy, BG Nagar, Karnataka 571418, India
| | - Murtaza M. Tambuwala
- School of Pharmacy and Pharmaceutical Science, University of Ulster, Coleraine, County Londonderry, Northern Ireland BT52 1SA, United Kingdom
| | - Emilio Clementi
- Clinical Pharmacology Unit, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Universita di Milano, Milan, Italy
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Fang JL, Loukotková L, Chitranshi P, Gamboa da Costa G, Beland FA. Effects of human sulfotransferases on the cytotoxicity of 12-hydroxynevirapine. Biochem Pharmacol 2018; 155:455-467. [DOI: 10.1016/j.bcp.2018.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/14/2018] [Indexed: 11/16/2022]
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Antunes AMM, Novais DA, da Silva JLF, Santos PP, Oliveira MC, Beland FA, Marques MM. Synthesis and oxidation of 2-hydroxynevirapine, a metabolite of the HIV reverse transcriptase inhibitor nevirapine. Org Biomol Chem 2011; 9:7822-35. [PMID: 21969039 DOI: 10.1039/c1ob06052j] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Alexandra M M Antunes
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001, Lisboa, Portugal.
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Antunes AMM, Godinho AL, Martins IL, Oliveira MC, Gomes RA, Coelho AV, Beland FA, Marques MM. Protein adducts as prospective biomarkers of nevirapine toxicity. Chem Res Toxicol 2010; 23:1714-25. [PMID: 20809596 PMCID: PMC2981636 DOI: 10.1021/tx100186t] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Nevirapine (NVP) is a non-nucleoside reverse transcriptase inhibitor used against human immunodeficiency virus type-1 (HIV-1), mostly to prevent mother-to-child HIV-1 transmission in developing countries. Despite its clinical efficacy, NVP administration is associated with a variety of toxic responses that include hepatotoxicity and skin rash. Although the reasons for the adverse effects of NVP administration are still unclear, increasing evidence supports the involvement of metabolic activation to reactive electrophiles. In particular, Phase II activation of the NVP metabolite 12-hydroxy-NVP is thought to mediate NVP binding to bionucleophiles, which may be at the onset of toxicity. In the present study, we investigated the nature and specific locations of the covalent adducts produced in human serum albumin and human hemoglobin by reaction in vitro with the synthetic model electrophile 12-mesyloxy-NVP, used as a surrogate for the Phase II metabolite 12-sulfoxy-NVP. Multiple sites of modification were identified by two different mass spectrometry-based methodologies, liquid chromatography-electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) and matrix-assisted laser desorption ionization tandem mass spectrometry (MALDI-TOF-TOF-MS). These two distinct methodologies, which in some instances afforded complementary information, allowed the identification of multiple adducts involving cysteine, lysine, tryptophan, histidine, serine, and the N-terminal valine of hemoglobin. Tryptophan, which is not a common site of covalent protein modification, was the NVP-modified amino acid residue detected in the two proteins and consistently identified by both LC-ESI-MS/MS and MALDI-TOF-TOF-MS. The propensity of tryptophan to react with the NVP-derived electrophile is further emphasized by the fact that human serum albumin possesses a single tryptophan residue, which suggests a remarkable selectivity that may be useful for biomonitoring purposes. Likewise, the NVP adduct with the terminal valine of hemoglobin, detected by LC-ESI-MS/MS after N-alkyl Edman degradation, appears as an easily assessed marker of NVP binding to proteins. Our results demonstrate the merits and complementarity of the two MS-based methodologies for the characterization of protein binding by NVP and suggest a series of plausible biomarkers of NVP toxicity that should be useful in the monitoring of toxicity effects in patients administered NVP.
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Affiliation(s)
- Alexandra M. M. Antunes
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001 Lisboa, Portugal
| | - Ana L.A. Godinho
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001 Lisboa, Portugal
| | - Inês L. Martins
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001 Lisboa, Portugal
| | - M. Conceição Oliveira
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001 Lisboa, Portugal
| | - Ricardo A. Gomes
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, 2781-901 Oeiras, Portugal
| | - Ana V. Coelho
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001 Lisboa, Portugal
| | - Frederick A. Beland
- Division of Biochemical Toxicology, National Center for Toxicological Research, Jefferson, AR 72079
| | - M. Matilde Marques
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, 1049-001 Lisboa, Portugal
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Ren C, Fan-Havard P, Schlabritz-Loutsevitch N, Ling Y, Chan KK, Liu Z. A sensitive and specific liquid chromatography/tandem mass spectrometry method for quantification of nevirapine and its five metabolites and their pharmacokinetics in baboons. Biomed Chromatogr 2010; 24:717-26. [PMID: 19882749 DOI: 10.1002/bmc.1353] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A highly sensitive and specific LC-MS/MS assay was developed and validated to quantify nevirapine (NVP) and its five metabolites [2-, 3-, 8-, 12-hydroxyl NVP (OHNVP) and 4-carboxyl NVP (CANVP)] simultaneously in baboon serum and the assay was used to characterize their pharmacokinetic studies of an oral-dose escalation study in baboon. The lower limit of quantification (LLOQ) for NVP and its four hydroxyl nevirapine metabolites was 1.0 ng/mL and for 4-CANVP was 5.0 ng/mL. The between-run and within-run precisions and accuracies at four quality control concentrations (1, 5, 50 and 500 ng/mL) were evaluated in baboon serum with less than 14% variation and 93-114% accuracies (n = 6), except for the LLOQ for 2-OHNVP, which had an accuracy of 115.8% for between-run validation. The pharmacokinetics of NVP and its five metabolites in non-pregnant baboons by a single-dose escalation study were also profiled. The major metabolites detected were 4-CANVP and 12-OHNVP. 3-OHNVP and 2-OHNVP were the minor metabolites with only a trace amount of 2-OHNVP detected in some pharmacokinetic samples. No 8-OHNVP was observed in all of the pharmacokinetic samples. In addition, the fragmentation for the four hydroxyl metabolite isomers is also discussed.
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Affiliation(s)
- Chen Ren
- College of Pharmacy, The Ohio State University, 500 W. 12th Avenue, Columbus, OH 43210, USA
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Antunes AMM, Godinho ALA, Martins IL, Justino GC, Beland FA, Marques MM. Amino acid adduct formation by the nevirapine metabolite, 12-hydroxynevirapine--a possible factor in nevirapine toxicity. Chem Res Toxicol 2010; 23:888-99. [PMID: 20392079 DOI: 10.1021/tx900443z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Nevirapine (NVP) is a non-nucleoside reverse transcriptase inhibitor used against the human immunodeficiency virus type-1 (HIV-1), mostly to prevent mother-to-child transmission of the virus in developing countries. However, reports of severe NVP-induced hepatotoxicity and serious adverse cutaneous effects have raised concerns about its use. NVP metabolism involves oxidation of the 4-methyl substituent to 4-hydroxymethyl-NVP (12-hydroxy-NVP) and the formation of phenolic derivatives. Further metabolism, through either oxidation to quinoid derivatives or phase II esterification, may produce electrophilic derivatives capable of reacting with bionucleophiles to yield covalent adducts. These adducts could potentially be involved in the initiation of toxic responses. To gain insight into potentially reactive sites in proteins and prepare reliable and fully characterized NVP-amino acid adduct standards for subsequent assessment as biomarkers of NVP toxicity, we have used the model electrophile, 12-mesyloxy-NVP, as a synthetic surrogate for the NVP metabolite, 12-sulfoxy-NVP. Reactions of this model ester were conducted with glutathione and the nucleophilic amino acids arginine, cysteine, histidine, and tryptophan. Moreover, because adducts through the N-terminal valine of hemoglobin are convenient biomarkers of exposure to electrophilic toxicants, we also investigated the reaction with valine. We obtained very efficient (>80%) binding through the sulfur of both glutathione and N-acetylcysteine and moderate yields (10-14%) for binding through C2 of the indole ring of tryptophan and N1 of the imidazole ring of histidine. Reaction with arginine occurred through the alpha-amino group, possibly due to the high basicity of the guanidino group in the side chain. Reaction at the alpha-amino group of valine occurred to a significant extent (33%); the resulting adduct was converted to a thiohydantoin derivative, to obtain a standard useful for prospective biomonitoring studies. All adducts were characterized by a combination of (1)H and (13)C NMR spectroscopy and mass spectrometry techniques. The NVP conjugates with glutathione and N-acetylcysteine identified in this work were previously reported to be formed in vivo, although the corresponding structures were not fully characterized. Our results support the validity of 12-mesyloxy-NVP as a surrogate for 12-sulfoxy-NVP and suggest that NVP metabolism to 12-hydroxy-NVP, and subsequent esterification, could potentially be a factor in NVP toxicity. They further imply that multiple sites in proteins may be targets for modification by 12-hydroxy-NVP-derived electrophiles in vivo. Additionally, we obtained reliable, fully characterized standards for the assessment of protein modification by NVP in vivo, which should help clarify the potential role of metabolism in NVP-induced toxicity.
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Affiliation(s)
- Alexandra M M Antunes
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade Técnica de Lisboa, Lisboa, Portugal.
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Pendela M, Van Gyseghem E, Van den Mooter G, Baert L, Rosier J, Hoogmartens J, Adams E. Development of a liquid chromatographic assay for an anti-HIV tablet containing lamivudine, zidovudine and TMC278.HCL. J Pharm Biomed Anal 2009; 49:508-12. [DOI: 10.1016/j.jpba.2008.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 10/21/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
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