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Horvath TD, Poventud-Fuentes I, Olayinka L, James A, Haidacher SJ, Hoch KM, Stevens AM, Haag AM, Devaraj S. Validation of atovaquone plasma levels by liquid chromatography-tandem mass spectrometry for therapeutic drug monitoring in pediatric patients. J Mass Spectrom Adv Clin Lab 2022; 26:23-27. [PMID: 36388060 PMCID: PMC9641598 DOI: 10.1016/j.jmsacl.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
Atovaquone, an antiparasitic and antifungal, has potential as an anticancer agent. Our LC-MS/MS-based method can accurately quantify atovaquone in plasma. Low LOQ and small sample volume requirements add versatility to our method. Measuring atovaquone in plasma helps to determine the effective dose in children.
Background Atovaquone has traditionally been used as an antiparasitic and antifungal agent, but recent studies have shown its potential as an anticancer agent. The high variability in atovaquone bioavailability highlights the need for therapeutic drug monitoring, especially in pediatric patients. The goal of our study was to develop and validate the performance of an assay to quantify atovaquone plasma concentrations collected from pediatric cancer patients using LC-MS/MS. Methods Atovaquone was extracted from a 10 µL volume of K2-EDTA human plasma using a solution consisting of ACN: EtOH: DMF (8:1:1 v:v:v), separated using reverse-phase chromatography, and detected using a SCIEX 5500 QTrap MS system. LC-MS/MS assay performance was evaluated for precision, accuracy, carryover, sensitivity, specificity, linearity, and interferences. Results Atovaquone and its deuterated internal standard were analyzed using a gradient chromatographic method that had an overall cycle-time of 7.4 min per injection, and retention times of 4.3 min. Atovaquone was measured over a dynamic concentration range of 0.63 – 80 µM with a deviation within ≤ ± 5.1 % of the target value. Intra- and inter-assay precision were ≤ 2.7 % and ≤ 8.4 %, respectively. Dilutional, carryover, and interference studies were also within acceptable limits. Conclusions Our studies have shown that our LC-MS/MS-based method is both reliable and robust for the quantification of plasma atovaquone concentrations and can be used to determine the effective dose of atovaquone for pediatric patients treated for AML.
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Affiliation(s)
- Thomas D. Horvath
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Izmarie Poventud-Fuentes
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Lily Olayinka
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Asha James
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Sigmund J. Haidacher
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Kathleen M. Hoch
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Alexandra M. Stevens
- Department of Pediatric Hematology/Oncology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Anthony M. Haag
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Sridevi Devaraj
- Department of Pathology and Immunology, Baylor College of Medicine, and Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
- Corresponding author.
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Bakshi RP, Tatham LM, Savage AC, Tripathi AK, Mlambo G, Ippolito MM, Nenortas E, Rannard SP, Owen A, Shapiro TA. Long-acting injectable atovaquone nanomedicines for malaria prophylaxis. Nat Commun 2018; 9:315. [PMID: 29358624 PMCID: PMC5778127 DOI: 10.1038/s41467-017-02603-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/12/2017] [Indexed: 12/04/2022] Open
Abstract
Chemoprophylaxis is currently the best available prevention from malaria, but its efficacy is compromised by non-adherence to medication. Here we develop a long-acting injectable formulation of atovaquone solid drug nanoparticles that confers long-lived prophylaxis against Plasmodium berghei ANKA malaria in C57BL/6 mice. Protection is obtained at plasma concentrations above 200 ng ml-1 and is causal, attributable to drug activity against liver stage parasites. Parasites that appear after subtherapeutic doses remain atovaquone-sensitive. Pharmacokinetic-pharmacodynamic analysis indicates protection can translate to humans at clinically achievable and safe drug concentrations, potentially offering protection for at least 1 month after a single administration. These findings support the use of long-acting injectable formulations as a new approach for malaria prophylaxis in travellers and for malaria control in the field.
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Affiliation(s)
- Rahul P Bakshi
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
| | - Lee M Tatham
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool, L69 3GF, UK
| | - Alison C Savage
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, UK
| | - Abhai K Tripathi
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Godfree Mlambo
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Matthew M Ippolito
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Elizabeth Nenortas
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
| | - Steve P Rannard
- Department of Chemistry, University of Liverpool, Crown Street, Liverpool, L69 7ZD, UK.
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Block H, 70 Pembroke Place, Liverpool, L69 3GF, UK.
| | - Theresa A Shapiro
- Division of Clinical Pharmacology, Departments of Medicine and of Pharmacology and Molecular Sciences, The Johns Hopkins University, 725 North Wolfe Street, Baltimore, MD, 21205, USA
- The Johns Hopkins Malaria Research Institute, Baltimore, MD, 21205, USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins University, Baltimore, MD, 21205, USA
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Xiao Y, Li X, Fu X. A rapid and simple LC-MS/MS method for personalized busulfan dosing in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Clin Chim Acta 2018; 479:190-195. [PMID: 29341904 DOI: 10.1016/j.cca.2018.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/11/2017] [Accepted: 01/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Busulfan is commonly used as a conditioning regimen before hematopoietic stem cell transplantation (HSCT). There is a big inter-individual variability in busulfan exposure and the narrow therapeutic index, especially in pediatric population. Therefore, to achieve therapeutic efficacy and safety concurrently, personalized busulfan dosing, guided by pharmacokinetic study with serial plasma samples, is needed a few hours afterwards. METHODS A fast, sensitive, and accurate method for busulfan measurement was developed, validated, and implemented with liquid-chromatography-mass spectrometry (HPLC-MS/MS). The sample preparation procedure involves only protein precipitation and dilution, and the HPLC-MS/MS method takes 3 min/sample. The assay was linear from 10 ng/ml to 7500 ng/ml (R2 = 0.99). Recoveries were above 90%. The precision was determined at 3 levels (30, 300 and 4000 ng/ml): the intra-day variability (%CV) ranged from 1.4% to 2.5% (n = 20); the inter-day variability ranged from 2.2% to 5.5% (n = 20). The accuracy of the HPLC-MS/MS test was evaluated with an old HPLC-fluorescence method (n = 84), and a Correlation Coefficient (R) of 0.99 was observed. CONCLUSIONS The analytical performance of the assay allows for timely dose adjustment and has been implemented in clinical service for better clinical outcome.
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Affiliation(s)
- Yi Xiao
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, United States
| | - Xiaohan Li
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Xiaowei Fu
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, United States; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, United States.
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Xiao Y, Xu YK, Pattengale P, O'Gorman MR, Fu X. A Rapid High-Performance LC-MS/MS Method for Therapeutic Drug Monitoring of Voriconazole, Posaconazole, Fluconazole, and Itraconazole in Human Serum. ACTA ACUST UNITED AC 2017; 1:626-636. [DOI: 10.1373/jalm.2016.022756] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
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