Effect of variability of plasma interferences on the accuracy of drug immunoassays

A simple quantitative method analysing amikacin, gentamicin, and vancomycin levels in human newborn plasma using ion-pair liquid chromatography/tandem mass spectrometry and its applicability to a clinical study

Neuroprotective controlled therapeutic hypothermia is the standard of care for newborns suffering perinatal asphyxia. Antibiotic drugs, such as amikacin, gentamicin, and vancomycin are frequently administered during controlled hypothermia, which possibly alters their pharmacokinetic (PK) and pharmacodynamic (PD) profiles. In order to examine this effect an LC-MS/MS method for the simultaneous quantification of amikacin, the major gentamicin components (gentamicin C, C1a and C2), and vancomycin in plasma was developed. In 25μL plasma proteins were precipitated with trichloroacetic acid (TCA) and detection of the components was achieved using ion-pair reversed phase chromatography coupled with electrospray ionization tandem mass spectrometry. The chromatographic runtime was 7.5min per sample. Calibration standards were prepared over a range of 0.3-50mgL(-1) for amikacin and gentamicin and 1.0-100mgL(-1) for vancomycin. At LLOQ accuracy was between 103 and 120% and imprecision was less than 19%. For concentrations above LLOQ accuracy ranged from 98% to 102% and imprecision was less than 6%. Process efficiency, ionization efficiency, and recovery were acceptable. Samples and stock solutions were stable during the time periods and at the different temperatures examined. The applicability of the method was shown by analysing plasma samples from 3 neonatal patients. The developed method allows accurate and precise simultaneous quantification of amikacin, gentamicin, and vancomycin in a small volume (25μL) of plasma.

Mass spectrometric quantification of AcSDKP-NH2 in human plasma and urine and comparison with an immunoassay

RATIONALE

Precise assessment of renal glomerular filtration rate (GFR) is essential for the early detection of chronic kidney disease. AcSDKP-NH(2), an analogue of the endogenous tetrapeptide AcSDKP, is not degraded in vivo and is freely filtered by the kidney and eliminated in urine; for that reason this analogue is an ideal candidate marker for the assessment of GRF after administration to humans. Proof-of-concept demonstration and lack of toxicity in animals have allowed an ongoing clinical study in which AcSDKP-NH(2) was administered intravenously at a dose of 100 µg and compared with currently available GFR markers. The use of the AcSDKP analogue in clinical practice requires that this novel marker be associated with an analytical method that combines specificity, robustness and high accuracy. We have developed a liquid chromatography/tandem mass spectrometry (LC/MS/MS) assay and compared it with an existing enzyme immunoassay (EIA) for AcSDKP-NH(2).

METHODS

Human urine and plasma samples from the clinical study were analyzed by EIA and LC/MS/MS. Before LC/MS/MS assessment, AcSDKP-NH(2) was extracted using mixed-mode cation-exchange solid-phase extraction cartridges. Chromatographic separation was performed by hydrophilic interaction liquid chromatography (HILIC), before analysis with an electrospray ionization triple quadrupole mass spectrometer.

RESULTS

Mass spectrometry, through the use of an internal standard, tailored sample preparation and chromatographic separation, has better intra- and inter-assay precision (accuracies between 95 and 101% with CVs <8% for LC/MS/MS vs. accuracies between 90 and 115% with CVs <18% for EIA) and allows greater steadiness in intra-subject concentrations during the infusion (4.4% for LC/MS/MS vs. 8.6% for EIA). Moreover, the LC/MS/MS assay circumvents matrix effects observed in certain instances for the EIA and which may reduce its accuracy.

CONCLUSIONS

Although the EIA can provide sufficient information in most subjects, the LC/MS/MS assay associated with this new marker should be the reference method.

Pharmacokinetics and tolerability of amikacin administered as BAY41-6551 aerosol in mechanically ventilated patients with gram-negative pneumonia and acute renal failure

BACKGROUND

BAY41-6551, a drug-device combination in development for adjunctive treatment of Gram-negative pneumonia in intubated and mechanically ventilated patients, consists of amikacin formulated for inhalation coupled with the Pulmonary Drug Delivery System (PDDS) Clinical aerosol delivery platform. Given the predominantly renal clearance of aminoglycosides, understanding systemic amikacin exposure and safety during administration of BAY41-6551 to patients with acute renal failure (ARF) is clinically important.

METHODS

Seven mechanically ventilated patients with Gram-negative pneumonia and ARF receiving continuous veno-venous hemodiafiltration (CVVHDF) were treated with multiple administrations of BAY41-6551 400 mg amikacin twice daily using the PDDS Clinical on-ventilator device [in addition to standard intravenous (i.v.) antimicrobial therapy]. CVVHDF parameters were recorded and a PK analysis was performed using serum, urine, and bronchoalveolar lavage fluid samples.

RESULTS

Maximum serum amikacin concentration [median 1.93 (range: 0.63-3.99) mg/L] and area under the concentration-time curve from zero to 12 h on day 3 [median 19.32 (range 6.32-36.87) mg · h/L] were elevated compared with mechanically ventilated patients with normal renal function; however, serum amikacin trough concentrations were within accepted safety limits. The median amikacin concentration in epithelial lining fluid [887 (range: 406-12,819) mg/L] was similar to that reported previously in mechanically ventilated patients with normal renal function. BAY41-6551 demonstrated acceptable safety and tolerability with most adverse events (AEs) as expected for the patient population. One serious AE of bronchospasm was attributed to the study medication; no reported AEs were related to the PDDS Clinical device.

CONCLUSIONS

CVVHDF appears to provide adequate clearance of systemically absorbed amikacin in mechanically ventilated patients with ARF, suggesting that dose adjustments for BAY41-6551 are probably not necessary for this patient population. Nonetheless, the standard precautionary measures for critically ill patients receiving i.v. amikacin should be followed for patients with ARF who are treated with BAY41-6551.

Development and validation of a novel HPLC/ELSD method for the direct determination of tobramycin in pharmaceuticals, plasma, and urine

A novel method for the direct determination of the aminoglycoside tobramycin was developed and validated based on reversed-phase high-performance liquid chromatography (RP-HPLC) with evaporative light scattering detector (ELSD). Using a Waters ODS-2 C18 Spherisorb column with an evaporation temperature of 45 degrees C and nitrogen pressure of 3.5 bar, the selected mobile phase consisted of water/acetonitrile 55:45 containing 1.5 mL L(-1) HFBA (11.6 mM) in an isocratic mode at a rate of 1.0 mL min(-1). Tobramycin's retention time was 4.3 min with an asymmetry factor of 1.7. A logarithmic calibration curve was obtained from 1 to 38 microg mL(-1) (r > 0.9998). LOD was 0.3 microg mL(-1); within-day %RSD was 1.0 (n = 3, 4.7 microg mL(-1)) and between-day %RSD was 1.1 (3 days within a week). The developed method was applied to the determination of tobramycin in a pharmaceutical crude substance and formulations (eye drops and ointments). Dilution experiments revealed the absence of interference from excipients (no constant and proportional errors); recovery from spiked samples was 99-103% with %RSD < 2.2 (n = 3x3). The developed HPLC/ELSD method was also found to be applicable in the determination of tobramycin in human plasma (0.6-12.5 microg mL(-1)) and urine (1.5-12.5 microg mL(-1)) after solid-phase extraction using carboxylate cartridges followed by solvent evaporation (x2 preconcentration). A mean recovery of 86% for plasma and 91% for urine was obtained.

Gentamicin assay in human serum by solid-phase extraction and capillary electrophoresis

We describe the development of a capillary electrophoresis method for the determination of gentamicin C1, C1a, C2a, and C2 components in human serum. Using a weak cation-exchanger with 20 mM phosphate buffer, pH 7.4, 200 mM borate buffer, pH 9.0, and ammonia/methanol, solid-phase extraction (SPE) of gentamicin components from the human sera was performed. The extract was derivatized with 1,2-phthalic dicarboxaldehyde/mercaptoacetic acid reagent. The derivatives were separated with a background electrolyte comprising 60 mM 2-(N-cyclohexylamino)ethanesulfonic acid (CHES) buffer at pH 9.5 containing 31.6% m/v methanol, and quantified with UV-light absorption detection at 230 nm. The identity of the gentamicin components was confirmed by mass spectrometry. The SPE recovery of the gentamicin ranged from 78% to 93%. The calibration curves were linear from the concentration limit of quantitation (LOQ) to 30 mg/L for the gentamicin mixture. The LOQ for gentamicin C1 was 0.33 mg/L, for C2a 0.23 mg/L, C2 0.25 mg/L, C1a 0.27 mg/L and the concentration limit of detection (LOD) for C1 was 0.15 mg/L, C2a 0.11 mg/L, C2 0.12 mg/L, C1a 0.13 mg/L. Intra-assay relative standard deviation (RSD) values were for C1 (5%), C1a (7%), C2 (6.5%) and C2a (9%); inter-assay RSD values were for C1 (11%), C1a (13.3%), C2 (15%) and C2a (14%). The Pearson's correlation between capillary electrophoresis and immunoassay revealed a linear relationship between these two techniques with r = 0.9. This method for determination of gentamicin C1, C1a, C2a, and C2 in human serum can thus be used in the entire therapeutic concentrations range of gentamicin.

Validation of a gas chromatography–mass spectrometry method for the determination of pg/ml levels of 17β-estradiol and 17β-trenbolone in bovine serum

A method for the quantitation of pg/ml levels of 17beta-estradiol and 17beta-trenbolone in bovine serum by gas chromatography/electron-capture mass spectrometry has been developed and validated. Using the area ratios of the integrated molecular-ion peaks of the analytes to their corresponding deuterated internal standards, [2,4,16,16-2H4] 17beta-estradiol (17beta-estradiol-d(4)) and [16,16-2H2] 17beta-trenbolone (17beta-trenbolone-d(2)), and non-weighted linear regression, two calibration curves per analyte; 5-50 and 50-500 pg/ml for 17beta-estradiol in sera, and 25-250 and 250-2500 pg/ml for 17beta-trenbolone in sera, respectively, were constructed. Splitless injection of 200 fg 17beta-estradiol and 1000 fg 17beta-trenbolone could be detected and quantified. Tested batches of control bovine sera did not exhibit interference for 17beta-trenbolone, and showed expected background presence of endogenous 17beta-estradiol. Intra-day residual errors did not exceed 20%, and regression correlations were greater than 0.99. Intra-day precision data was similar to inter-day precision data. Using this method, 16 samples can be processed within one working day.

Determination of tobramycin in serum using liquid chromatography-tandem mass spectrometry and comparison with a fluorescence polarisation assay

We have developed a tandem mass spectrometry (LC-MS-MS) method for measuring tobramycin concentrations in serum samples and have compared it with a fluorescence polarisation immunoassay. After protein precipitation with acetonitrile supernatant was injected into the LC-MS-MS system. A C(18) cartridge (4x2 mm) was eluted with a step gradient of 20-100% methanol containing HFBA. The retention times were, tobramycin 1.05 min and sisomycin 1.05 min. The MRM transitions were: m/z 467.8>163 (tobramycin) and m/z 447.8>160 (sisomycin). The limit of quantification was 0.15 mg/l and the assay was linear up to 50 mg/l. Assay precision was <6% within and between batch.

Determination of Gentamicins C1, C1a, and C2 in Plasma and Urine by HPLC

Background: Gentamicin is an aminoglycoside antibiotic complex containing gentamicins C1, C1a, and C2. Few methods have been described for analysis of the three gentamicin components separately in biological fluids, and none has been used in pharmacokinetic studies. Determination of the three gentamicins separately may have pharmacokinetic and toxicological implications. The present study describes development of an HPLC method for the analysis of gentamicin C1, C1a, and C2 components in plasma and urine.

Methods: The three components were isolated by preparative chromatography and their identities verified by thin-layer chromatography, HPLC, mass spectrometry, nuclear magnetic resonance spectroscopy, and melting point determination. The gentamicins were extracted from the biological matrix by use of Tris buffer and polymer phase solid-phase extraction. Derivatization was carried out in the solid-phase extraction cartridge with 1-fluoro-2,4-dinitrobenzene. The 2,4-dinitrophenyl derivatives were separated with reversed-phase HPLC and quantified by the ultraviolet absorbance at 365 nm.

Results: The detector response was linear from the limit of quantification to 50 mg/L for the individual components. The limit of quantification was 0.07 mg/L for gentamicin C1 and 0.1 mg/L for gentamicins C2 and C1a. The recovery of the gentamicin components was 72% from plasma and 98% from urine. The method was validated for human and dog plasma and urine.

Conclusions: The method was repeatable and enabled the analysis of gentamicins C1, C1a, and C2 in plasma and urine in concentrations covering the therapeutic range of the drug, thus being suitable for therapeutic drug monitoring and pharmacokinetic studies.