Study of twenty preparations of human albumin solution which failed in quality control testing due to elevated sodium content, a poor internal quality control at manufacturing unit

Current study is conducted in our laboratory due to failure in quality control testing of twenty batches of Human Albumin solution in which sodium content is higher than the prescribed limit. These batches are received in short duration from indigenous manufacturer and is the first incident of failure of Human albumin preparation in sodium content of manufacturer. On request of manufacturer, study is conducted to rule out the cause. Repeat testing of each out of specification batch is conducted and a trend analysis is drawn between our findings and manufacturer's results, also study of trend analysis of manufacturer for the last one year. Trend analysis data indicated towards poor consistency of batches with major shift at various time intervals in sodium content of human albumin preparation. Further analysis rule out that non-traceable quality of standard used in the internal quality control testing by manufacturer is the root cause of the problem.

Collaborative study for the calibration of the Ph. Eur. prekallikrein activator in albumin BRP batches 4, 5 and 6

An international collaborative study was organised by the European Directorate for the Quality of Medicines & HealthCare (EDQM, Council of Europe) to calibrate replacement batches for the current European Pharmacopoeia (Ph. Eur.) prekallikrein activator (PKA) in albumin biological reference preparation (BRP), whose stocks were dwindling. The study was run in the framework of the Biological Standardisation Programme (BSP) of the Council of Europe and the European Union (EU) Commission. Twenty three laboratories from official medicines control authorities and manufacturers in Europe and outside Europe took part in the study. Three candidate replacement batches were produced from the same material as the one used for the World Health Organization (WHO) 2(nd) International Standard (IS) for PKA in albumin (02/168) and the Ph. Eur. PKA in albumin BRP batches 1, 2 and 3. Participants were requested to evaluate the candidate batches against the current WHO IS using their routine assay method. The Ph. Eur. PKA in albumin BRP batch 3 (BRP3) was also included in the test panel to ensure the continuity of the consecutive BRP batches. The study confirmed the stability of the PKA content of the current BRP3. The candidate batches were found to be comparable. Previous data on the starting material support its high stability. Thermal stress study on the candidate batches confirmed the stability of their PKA activity. The Commission of the Ph. Eur. officially adopted in November 2013 the 3 candidate batches as Ph. Eur. PKA in albumin BRP batches 4, 5 and 6 with an assigned content of 38 IU/vial. The activity of the 3 new batches of Ph. Eur. PKA in albumin BRP will be regularly monitored.

Establishment of the human albumin for electrophoresis Ph. Eur. BRP batches 3 and 4

Due to the diminished stocks of the 2nd batch of the European Pharmacopoeia (Ph. Eur.) Biological Reference Preparation (BRP) for human albumin for electrophoresis, the European Directorate for the Quality of Medicines & HealthCare (EDQM) initiated in 2014 an international collaborative study for the establishment of two replacement batches. The study was run under the aegis of the Biological Standardisation Programme (BSP). Thirteen laboratories participated in the collaborative study to verify the suitability of the candidate reference preparations according to the Ph. Eur. monograph 0255 using the zone electrophoresis (ZE) method with either cellulose acetate and/or agarose as the testing medium. The candidate preparations were found suitable for the intended purpose and were subsequently adopted in June 2015 by the Ph. Eur. Commission as human albumin for electrophoresis BRP batches 3 and 4 with an assigned range for albumin of 93.8 per cent to 98.3 per cent of the total protein content.

Quantitative guidelines for the prediction of ultrasound contrast agent destruction during injection

Experiments and theory were undertaken on the destruction of ultrasound contrast agent microbubbles on needle injection, with the aim of predicting agent loss during in vivo studies. Agents were expelled through a variety of syringe and needle combinations, subjecting the microbubbles to a range of pressure drops. Imaging of the bubbles identified cases where bubbles were destroyed and the extent of destruction. Fluid-dynamic calculations determined the pressure drop for each syringe and needle combination. It was found that agent destruction occurred at a critical pressure drop that depended only on the type of microbubble. Protein-shelled microbubbles (sonicated bovine serum albumin) were virtually all destroyed above their critical pressure drop of 109 ± 7 kPa Two types of lipid-shelled microbubbles were found to have a pressure drop threshold above which more than 50% of the microbubbles were destroyed. The commercial lipid-shelled agent Definity was found to have a critical pressure drop for destruction of 230 ± 10 kPa; for a previously published lipid-shelled agent, this value was 150 ± 40 kPa. It is recommended that attention to the predictions of a simple formula could preclude unnecessary destruction of microbubble contrast agent during in vivo injections. This approach may also preclude undesirable release of drug or gene payloads in targeted microbubble therapies. Example values of appropriate injection rates for various agents and conditions are given.

The FDA's assessment of follow-on protein products: a historical perspective

The scientific and regulatory issues that are associated with the possible introduction of 'follow-on' versions of protein drug products are the topic of considerable debate at present. Because of the differences between protein drug products and small-molecule drugs, the development of follow-on versions of protein products presents more complex scientific challenges than those presented by the development of generic versions of small-molecule drugs. Here, with a view to illustrating the Food and Drug Administration's (FDA's) scientific reasoning and experience in this area, we discuss past examples of the FDA's actions involving the evaluation of various types of follow-on and second-generation protein products and within-product manufacturing changes. The FDA believes its evaluation of the safety and effectiveness of follow-on protein products will evolve as scientific and technological advances in product characterization and manufacturing continue to reduce some of the complexity and uncertainty that are inherent in the manufacturing of protein products.

Hyaluronic acid versus albumin in human embryo transfer medium

We compared the implantation and pregnancy rate through in vitro fertilization (IVF) using hyaluronic acid and albumin as transfer medium in 60 women randomly allocated to 2 groups. In treatment group A (n = 30), embryos were transferred to medium supplemented with hyaluronic acid. In the control group B (n = 30), embryos were transferred to medium containing albumin. There were no significant differences between the groups in terms of mean age of the females, mean duration of infertility and mean number of embryos. The pregnancy rate in groups A and B were 81.8% and 71.4% respectively, a non-statistically significant difference. Hyaluronic acid can successfully replace albumin as transfer medium.

Impact of manufacturing improvements on clinical safety of albumin: Australian pharmacovigilance data for 1988-2005

OBJECTIVE

To evaluate the impact of manufacturing improvements on the clinical safety of human albumin solutions in Australia.

METHODS

This retrospective study examined the incidence of spontaneously reported post-market adverse drug reactions (ADRs) in Australia associated with successive generations of albumin products manufactured by the Bioplasma Division of CSL Limited (CSL Bioplasma) over 18 years (1988-2005). Key characteristics of each product generation which could affect clinical safety, such as purity, aggregates and prekallikrein activator (PKA) levels, were also identified from CSL batch release records.

RESULTS

A total of 3.7 million bottles of iso-oncotic and hyperoncotic albumin products were distributed in Australia over the period. Improvements to manufacturing processes resulted in products with increased albumin purity, lower levels of impurities such as aggregates and PKA, and reduced batch-to-batch variation. The total ADR incidence (number of ADRs per 100 000 bottles distributed) associated with the products currently supplied was 1.5 and 1.7 for Albumex 4 (2VI) and Albumex 20 (2VI), respectively. This was a significant reduction compared with the earlier generation products Stable Plasma Protein Solution (14.1) and 20% Normal Serum Albumin (11.5), respectively (P<0.0001). In particular, hypotensive reactions declined substantially.

CONCLUSION

Post-market pharmacovigilance data collected for successive generations of human albumin products supplied in Australia over 18 years indicates that manufacturing improvements have significantly improved the clinical safety profile of this product.

Validation of high-throughput methods for measuring blood urea nitrogen and urinary albumin concentrations in mice

Chronic kidney disease is a substantial medical and economic burden. Animal models, including mice, are a crucial component of kidney disease research; however, recent studies disprove the ability of autoanalyzer methods to accurately quantify plasma creatinine levels, an established marker of kidney disease, in mice. Therefore, we validated autoanalyzer methods for measuring blood urea nitrogen (BUN) and urinary albumin concentrations, 2 common markers of kidney disease, in samples from mice. We used high-performance liquid chromatography to validate BUN concentrations measured using an autoanalyzer, and we utilized mouse albumin standards to determine the accuracy of the autoanalyzer over a wide range of albumin concentrations. We observed a significant, linear correlation between BUN concentrations measured by autoanalyzer and high-performance liquid chromatography. We also found a linear relationship between known and measured albumin concentrations, although the autoanalyzer method underestimated the known amount of albumin by 3.5- to 4-fold. We confirmed that plasma and urine constituents do not interfere with the autoanalyzer methods for measuring BUN and urinary albumin concentrations. In addition, we verified BUN and albuminuria as useful markers to detect kidney disease in aged mice and mice with 5/6-nephrectomy. We conclude that autoanalyzer methods are suitable for high-throughput analysis of BUN and albumin concentrations in mice. The autoanalyzer accurately quantifies BUN concentrations in mouse plasma samples and is useful for measuring urinary albumin concentrations when used with mouse albumin standards.

Clinical usefulness of intravenous albunex for the Doppler assessment of aortic stenosis

Optimal Doppler recordings of stenotic aortic flow are not always easy to obtain. Therefore, the present study investigated how useful intravenous Albunex injections were for improving the Doppler assessment of pressure gradients for aortic stenosis in 20 consecutive patients who underwent Doppler and left-heart catheterization studies within a 1-week period. Continuous-wave Doppler echocardiography was performed using both a 2.5 MHz duplex and a 1.9MHz independent transducer before and after Albunex injections. The maximum and mean pressure gradients were calculated from the highest Doppler velocity tracings using the simplified Bernoulli equation. Pullback catheterization pressure tracings from the left ventricle to the ascending aorta were superimposed for determination of the maximum instantaneous and mean pressure gradients. The Doppler-derived peak and mean pressure gradients showed significant underestimation compared with the catheterization gradients (23+/-17 mmHg and 11+/-7 mmHg, respectively). However, this underestimation disappeared with Albunex injection (-2+/-7 mmHg and -1+/-4mmHg, respectively). Although the Doppler-derived instantaneous and mean pressure gradients correlated well with the catheterization gradients (r=0.909 and r=0.879, respectively), they became much closer with Albunex (r=0.987 and r=0.963, respectively). The improvements in the Doppler-derived peak pressure gradients were significant from an apical window (n=12, 84-120mmHg, p<0.001). but less so from non-apical windows (n=8, 84-91 mmHg, p=0.0146). Accordingly, Albunex is most useful for Doppler recordings of stenotic aortic flow available from the apical window, but not less so from other acoustic windows.

Standard properties of ultrasound contrast agents

A standardization procedure for in vitro acoustic characterization of ultrasound contrast agents is presented. One new acoustic parameter for particular importance is retained: This is STAR, scattering-to-attenuation ratio, for quantification of the effectiveness of the contrast agent. The STAR expresses the ability of the contrast agent to enhance the visualization of the tissue containing the contrast agent and, at the same time, represents the degree of its absorption. So, it is desirable to produce a contrast agent with high STAR, having good scattering properties to improve the image visualization, and low attenuation to image the underlying biological structures and to avoid shadowing. In this study, we present methods for calculations and measurements of the STAR and comparison between different contrast agents.

A survey of the values of clinical chemistry parameters obtained for a common rat blood sample in ninety-eight Japanese laboratories

A control survey was conducted to check the accuracy of automated analyzers used in the evaluation of clinical chemistry parameters in nonclinical toxicology studies. Pooled serum samples from male Sprague-Dawley rats were delivered refrigerated to each facility 98 laboratory facilities throughout Japan within 18 hours after sample preparation and analyzed. Commercially available normal human serum samples from a single lot were also analyzed at the same time. Survey results were divided into three categories. (1) Parameters with small coefficient of variation (CV) values for both rat and human serum samples included protein, glucose, cholesterol (CHO), urea nitrogen (UN), sodium (Na), potassium (K), chloride (Cl), calcium (Ca), and inorganic phosphate (IP). Definition of normal values in rats should be straight forward for these parameters. (2) Parameters with large CV values, but with a relatively good correlation between rat and human values include triglycerides (TG), glutamic oxaloacetic transaminase/aspartate aminotransferase (GOT/AST), glutamic pyruvic transaminase/alanine aminotransferase (GPT/ALT), and alkaline phosphatase (ALP). Measurements based on different principles gave different mean values, and this values contributed to the increase in CV values. Assessment of normal values would require a consideration of the measurement principles. (3) Parameters with large CV values only in rat serum samples included albumin (albumin/globulin ratio: A/G ratio), creatinine (CRE), and total bilirubin(BIL). Reactivity was different in rat albumin (ALB), depending on the reagents used. This difference needs to be corrected with values available by electrophoresis, or adjusted by rat ALB values, because of the lack of an appropriate measurement method. The enzyme method gave low values for rat CRE, which suggests the need for further examination of this method. The BIL values were extremely low in rat samples. It seems to be necessary to select appropriate methods to measure clinical pathology parameters correctly for rats. There was no deviation in values due solely to the mechanical operations of the analytical equipment. Non-standard initial settings of the equipment (equipment originally intended for human samples, but now applied to animal samples) was the main cause of the wide range of analytical values seen.

Quantification of albumin in cerebrospinal fluid

A standard spectrophotometric method for the quantitation of urinary albumin using bromphenol blue is evaluated to determine whether this method could be used to quantify cerebrospinal fluid albumin. In the modified procedure, 200 microliters of sample is added to 3 ml of bromphenol blue solution and the absorbance is read spectrophotometrically at 610 nm. Using standards and controls, the results were compared with known values and found to be both precise and accurate. The bromphenol blue method was compared with an immunoturbidometric method and found to be more precise and accurate, easier to perform, and cost effective. When compared to other dye-binding methods the bromphenol blue method is unique in its extremely low linear range and limit of detection. A minor disadvantage was the increased sample size necessary to obtain the increased precision.

The role of different albumin preparations on production of human plasma lipoprotein-like particles in vitro

Because we found apoprotein contamination of some high-grade commercial albumins, we studied this effect on formation of lipoprotein-like particles during lipolysis of human very low density lipoprotein (VLDL) in vitro. After a 1-hr incubation with purified bovine milk lipoprotein lipase, over 98% VLDL triglyceride was hydrolyzed in the presence of either albumin B (apoprotein-rich) or albumin C (apoprotein-poor), with a weight ratio of albumin to triglyceride of 60 to 1. Lipoproteins of density < 1.019 g/ml ("IDL"), 1.019 to 1.063 g/ml ("LDL"), and 1.063 to 1.21 g/ml ("HDL") were then isolated by ultracentrifugation. Recovery of non-triglyceride VLDL constituents in "IDL" and "LDL" was similar for albumin B or albumin C. "LDL" was the major catabolic product of in vitro VLDL lipolysis independent of the albumin used. The yield of "HDL," however, was 5- to 6-fold greater with albumin B. All lipoproteins produced with albumin B were richer in phospholipid, apoproteins C and A-I, relative to lipoproteins produced in the presence of albumin C. With albumin B, cholesterol/phospholipid molar ratios were <1 in all in vitro produced lipoproteins, but were >1 with albumin C. All these differences can be ascribed to the presence in albumin B of 0.2 mg apoprotein A-I/g albumin and 1.8 mg phospholipid/g albumin; these components were not detected in albumin C. Thus, two thirds of "HDL" recovered with VLDL lipolysis in the presence of albumin B can be accounted for by albumin itself and only one third from constituents of VLDL. Adding equivalent amounts of both apoproteins removed from albumin B and phospholipid to albumin C markedly decreased the disparities in results but addition of each alone did not. These results prove "inert" albumins serve other than as fatty acid and lysolecithin acceptors in in vitro model systems, and do influence formation of lipoproteins during in vitro VLDL catabolism.-Deckelbaum, R. J., T. Olivecrona, and M. Fainaru. The role of different albumin preparations on production of human plasma lipoprotein-like particles in vitro.

Effect of aggregates on albumin standardization

In order to investigate the consequences of presence of aggregates in human albumin standards, pools of monomer, dimer and polymer albumin were prepared and quantitated by three total-protein methods (biuret, Folin-Lowry and spectrophotometry at 279 nm) and by four different albumin methods (dye-binding by bromcresol green, electroimmunoassay, radial immunodiffusion and automated immunoprecipitation). Biuret was chosen as the reference method and the monomer was used as the standard in all methods. Both the total-protein and albumin methods gave values for aggregated albumin different from the biuret values. The maximal bias occurred in radial immunodiffusion where quantitation of the dimer and polymer pools gave only 67% and 48% of the biuret values, respectively. In five commercial albumin preparations investigated, the content of di- and polymer varied from 3 to 34%. Uncritical use of albumin preparations in standardization may thus introduce bias in the measurements.

[A further case of albumin auto-agglutination in a blood donor]

A blood donor is described whose serum contains an albumin active agglutinin reacting with autologous as well as normal donors red cells. Natrium caprylate present in some commercial albumin preparations is show to be co-responsible for this unusual reaction which cause difficulties or errors in Rh grouping.