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Liu M, Zhang J, Dong L, Xue W, He Q, Liang W, Liu X, Zhang J, Gu L, Feng Y, Yang J, Wang H, Wang Y, Li K, Li Y, Kong W, Zhang X, Yao M, Wang K, Ma P, Zhang W. Detection of sivelestat and its metabolite in small volumes of plasma from Chinese ALI/ARDS patients with SIRS via high-throughput UPLC-MS/MS: A pharmacokinetic study. J Pharm Biomed Anal 2020; 195:113876. [PMID: 33429252 PMCID: PMC7833710 DOI: 10.1016/j.jpba.2020.113876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/15/2020] [Accepted: 12/26/2020] [Indexed: 01/08/2023]
Abstract
In this study, we developed a sensitive and efficient analytical approach combining a 96-well plate-based protein precipitation strategy with ultra-performance liquid chromatography electrospray ionization tandem mass spectrometry (UPLC-MS/MS) in order to assess the pharmacokinetic (PK) properties of sivelestat and its metabolite XW-IMP-A in samples of plasma from ALI/ARDS patients with SIRS. The samples were separated via gradient elution with a C18 column (Phenomenex Kinetex, C18, 2.6 μm, 100 Å, 50 × 2.1 mm) using 0.1 % formic acid aqueous solution (A) and acetonitrile-methanol (1:1, V:V) (B) as a mobile phase at a 0.6 mL/min flow rate. UPLC-MS/MS spectra were generated in positive ion mode, and multiple reaction monitoring (MRM) was used to detect the following transitions: m/z 435.1 → 360.0 for sivelestat, m/z 469.0 → 394.0 for sivelestat-IS, m/z 351.0 → 276.0 for XW-IMP-A, and m/z 384.9 → 310.0 for XW-IMP-A-IS. This assay was run for 2.5 min in total, and achieved lowest limit of quantitation values of 2.0 ng/mL and 0.5 ng/mL for sivelestat and XW-IMP-A, respectively, while remaining highly linear from 2-500 ng/mL for sivelestat (r2 ≥ 0.9900) and from 0.5-125 ng/mL for XW-IMP-A (r2 ≥ 0.9900). These validated data were consistent with US Food and Drug Administration (FDA) and European Medicines Agency (EMA) acceptance criteria. In addition, this method was successfully applied to the steady-state PK evaluation of ALI/ARDS patients with SIRS.
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Affiliation(s)
- Mingzhou Liu
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China.
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Lingfang Dong
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Wenhua Xue
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Qilin He
- WuXi AppTec (Shanghai) Co., Ltd, Shanghai, China
| | | | - Xing Liu
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Jingying Zhang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Li Gu
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Yinghua Feng
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Jie Yang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Haibo Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Yaqin Wang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Kun Li
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Yuanlong Li
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China
| | - Weiqin Kong
- Umins (Wuhan) Pharmaceutical Co., Ltd, Wuhan, Hubei, 430000, China
| | - Xiaojian Zhang
- Department of Respiratory and Critical Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Mengying Yao
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Kai Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China.
| | - Peizhi Ma
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China.
| | - Wei Zhang
- Department of Pharmacy, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, China.
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Okamoto H, Onodera K, Kamba R, Taniyama Y, Sakurai T, Heishi T, Teshima J, Hikage M, Sato C, Maruyama S, Onodera Y, Ishida H, Kamei T. Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. J Thorac Dis 2018; 10:2206-2212. [PMID: 29850124 DOI: 10.21037/jtd.2018.03.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The mortality rate of spontaneous esophageal rupture remains 20% to 40% due to severe respiratory failure. We have performed thoracoscopic surgery for esophageal disease at our department since 1994. Sivelestat sodium hydrate reportedly improves the pulmonary outcome in the patients with acute lung injury (ALI). Methods We retrospectively evaluated the usefulness of thoracoscopic surgery and perioperative administration of sivelestat sodium hydrate for spontaneous esophageal rupture in 12 patients who underwent thoracoscopy at our department between 2002 and 2014. Results The patient cohort included 11 males and one female (median age, 61 years). The lower left esophageal wall was perforated in all patients. Surgical procedures consisted of thoracoscopic suture and thoracic drainage in six patients, transhiatal suture and thoracoscopic thoracic drainage in five, and thoracoscopic esophagectomy and thoracic drainage in one. The median time from onset to surgery was 8 hours with a surgical duration of 210 minutes, blood loss 260 mL, postoperative ventilator management 1 day, intensive care unit (ICU) stay 5 days, and interval to restoration of oral ingestion 13 days. Postoperative complications included respiratory failure in four patients, pyothorax in three, and leakage in one. There was no instance of perioperative mortality. Regarding perioperative administration of sivelestat sodium hydrate, the postoperative arterial oxygen partial pressure-to-fractional inspired oxygen ratio (P/F) and C-reactive protein (CRP) levels in the administration group were significantly better than those in the non-administration group on postoperative days 4 (P=0.035) and 5 (P=0.037), respectively. In contrast, there was no significant difference between the groups in median time of ventilator management, ICU stay, oral ingestion following surgery, or hospital stay. Conclusions Thoracoscopic surgery obtained acceptable results in all patients, including two with a significant time elapse from onset to treatment. Furthermore, sivelestat sodium hydrate was suggested to help improve postoperative respiration and inflammatory response.
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Affiliation(s)
- Hiroshi Okamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ko Onodera
- Department of General Practitioner Development, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Rikiya Kamba
- Department of Surgery, Osaki Citizen Hospital, Osaki, Japan
| | - Yusuke Taniyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Tadashi Sakurai
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takahiro Heishi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Jin Teshima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Makoto Hikage
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Sendai City Hospital, Sendai, Japan
| | - Chiaki Sato
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shota Maruyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yu Onodera
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hirotaka Ishida
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
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Wang ZQ, Chen LQ, Yuan Y, Wang WP, Niu ZX, Yang YS, Cai J. Effects of neutrophil elastase inhibitor in patients undergoing esophagectomy: A systematic review and meta-analysis. World J Gastroenterol 2015; 21:3720-3730. [PMID: 25834341 PMCID: PMC4375598 DOI: 10.3748/wjg.v21.i12.3720] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 06/23/2014] [Accepted: 07/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the benefit and safety of sivelestat (a neutrophil elastase inhibitor) administration in patients undergoing esophagectomy.
METHODS: Online databases including PubMed, EMBASE, the Cochrane Library, Web of Knowledge, and Chinese databases (Wanfang database, VIP and CNKI) were searched systematically up to November 2013. Randomized controlled trials and high-quality comparative studies were considered eligible for inclusion. Three reviewers evaluated the methodological quality of the included studies, and Stata 12.0 software was used to analyze the extracted data. The risk ratio (RR) was used to express the effect size of dichotomous outcomes, and mean difference (MD) or standardized mean difference was used to express the effect size of continuous outcomes.
RESULTS: Thirteen studies were included in this systematic review and nine studies were included in the meta-analysis. The duration of mechanical ventilation was significantly decreased in the sivelestat group on postoperative day 5 [I2 = 76.3%, SMD = -1.41, 95%CI: -2.63-(-0.19)]. Sivelestat greatly lowered the incidence of acute lung injury in patients after surgery (I2 = 0%, RR = 0.27, 95%CI: 0.08-0.93). However, it did not decrease the incidence of pneumonia, intensive care unit stay or postoperative hospital stay, and did not increase the incidence of complications such as anastomotic leakage, recurrent nerve palsy, wound infection, sepsis and catheter-related fever.
CONCLUSION: A neutrophil elastase inhibitor is beneficial in patients undergoing esophagectomy. More high quality, large sample, multi-center and randomized controlled trials are needed to validate this effect.
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