Automation of tacrolimus measurement on volumetric absorptive microsampling devices by tandem mass spectrometry

Pain and feasibility of capillary self-blood collection in general practice: A cross-sectional investigative study

BACKGROUND

Capillary self-blood collection (SBC) with mailed samples enables remote laboratory monitoring without in-person healthcare visits. This approach may improve continuity of care for patients, especially with chronic conditions.

OBJECTIVES

Compare pain perception between venous blood draws and capillary SBC and evaluate the usability and blood volume yield of SBC devices.

METHODS

In this cross-sectional study, general practice patients from mid of Germany, Germany performed SBC using the Tasso+® upper-arm device and mailed samples to a laboratory. Pain, usability, SBC volume, and associated factors were analysed using bivariate and general linear models.

RESULTS

Of 106 patients, 57.5% performed SBC without assistance. Self-perceived pain was lower among SBC draws (0.13, SD = 0.42) versus venous draws (1.21, SD = 1.60) (p < .001). 59.4% self-collected ≥130 μL blood plasma. Patient characteristics were not associated with SBC volume in regression analysis. Overall, the mean System Usability Scale (SUS) score was 86.2, indicating high usability. Lower school education was associated with lower usability scores, while lower fear of blood and needles were associated with higher usability scores in regression analysis.

CONCLUSIONS

Capillary SBC had high feasibility and usability and caused less pain than venous draws in the general practice setting. SBC shows promises for enabling remote laboratory monitoring.

Review: the role of automation in improving the performance and throughput of microsample bioanalysis

BACKGROUND

Microsampling is one of the most dynamic and rapidly evolving topics in bioanalysis. It can provide numerous advantages in comparison to traditional biological fluid sampling (safety and analyte stability, feasible shipping, lower storage expenses and increased environmental friendliness). All these advantages can be put to ideal use if microsampling is coupled to advanced automation. Most modern microsampling techniques are designed for optimal automatability of the sampling procedure, or of any of the subsequent analytical workflow steps, so that the usual advantages of the former can be enhanced by increased throughput, better safety and lower per-analysis expenses. However, finding relevant information on recent advances in automation for the bioanalysis of microsamples is still a challenging task.

RESULTS

In this review paper with 91 references, the most recent and relevant applications of full automation and semi-automation in biological microsample analysis are presented, with notes on the advantages and limitations of each approach. Some less recent examples are also presented, providing context or insight into the evolution of subsequent developments. This unique approach allows a better understanding of the close intertwining and complementarity of microsampling, automation and miniaturised sample preparation, an integration that is essential to ensure optimal and reliable results. Differences between classical and advanced microsampling techniques regarding their performance related to overall process automation are clearly laid out. Ample space is reserved for discussion on the most recent trends and what the authors believe will be the most important future developments.

SIGNIFICANCE

This review paper shows for the first time how coupling microsampling to analytical workflow automation could be the tipping point that will help microsampling become fully established in routine bioanalysis. Most disadvantages of microsampling can be either alleviated, outright solved or made irrelevant by automation, and this unprecedented development has the potential to revolutionise an entire research and application field. This is true in most use cases, including therapeutic drug monitoring, forensics, anti-doping and preclinical, clinical and toxicological studies.

Microsampling techniques and patient-centric therapeutic drug monitoring of immunosuppressants

Immunosuppressive pharmacotherapy after solid organ transplantation (SOT) requires therapeutic drug monitoring (TDM) for therapy individualization. The venous whole blood is still considered as routine matrix for monitoring immunosuppressive drug concentration. On the other hand, as an alternative, capillary blood collected using noninvasive sampling is convergent with a patient-centric approach. Despite their disadvantages regarding sample homogeneity and the hematocrit effect, well-known dried blood spot techniques have shown promising results. Volumetric absorptive microsampling (VAMS) and quantitative dried blood spot (qDBS) have successfully eliminated these unfavorable biased elements. Microsampling can be used in transplant recipients' care, mainly due to long-term therapy under control drug concentrations and the long distance between the place of the patient's residence and the diagnostic laboratory in the transplant center. The study aimed to discuss the clinical consequences of implementing microsampling techniques for TDM of immunosuppressants. Additionally, we have discussed the 'hot topics' in microsampling: home-based self-sampling, adherence to therapy monitoring, and drug concentration conversion to estimated traditional matrices. Finally, based on our experience and current practice, we propose best practices for microsampling implementation from bench to bedside. Microsampling techniques can potentially revolutionise immunosuppressive pharmacotherapy by enabling patient-centric individualisation in various subpopulations, significantly improving post-transplant care.

Push forward LC-MS-based therapeutic drug monitoring and pharmacometabolomics for anti-tuberculosis precision dosing and comprehensive clinical management

The spread of tuberculosis (TB), especially multidrug-resistant TB and extensively drug-resistant TB, has strongly motivated the research and development of new anti-TB drugs. New strategies to facilitate drug combinations, including pharmacokinetics-guided dose optimization and toxicology studies of first- and second-line anti-TB drugs have also been introduced and recommended. Liquid chromatography-mass spectrometry (LC-MS) has arguably become the gold standard in the analysis of both endo- and exo-genous compounds. This technique has been applied successfully not only for therapeutic drug monitoring (TDM) but also for pharmacometabolomics analysis. TDM improves the effectiveness of treatment, reduces adverse drug reactions, and the likelihood of drug resistance development in TB patients by determining dosage regimens that produce concentrations within the therapeutic target window. Based on TDM, the dose would be optimized individually to achieve favorable outcomes. Pharmacometabolomics is essential in generating and validating hypotheses regarding the metabolism of anti-TB drugs, aiding in the discovery of potential biomarkers for TB diagnostics, treatment monitoring, and outcome evaluation. This article highlighted the current progresses in TDM of anti-TB drugs based on LC-MS bioassay in the last two decades. Besides, we discussed the advantages and disadvantages of this technique in practical use. The pressing need for non-invasive sampling approaches and stability studies of anti-TB drugs was highlighted. Lastly, we provided perspectives on the prospects of combining LC-MS-based TDM and pharmacometabolomics with other advanced strategies (pharmacometrics, drug and vaccine developments, machine learning/artificial intelligence, among others) to encapsulate in an all-inclusive approach to improve treatment outcomes of TB patients.