@article{WohlfartHolzgrabe2021,
  author    = {Wohlfart, Jonas and Holzgrabe, Ulrike},
  title     = {Analysis of histamine and sisomicin in gentamicin: search for the causative agents of adverse effects},
  series = {Archiv der Pharmazie},
  volume    = {354},
  journal   = {Archiv der Pharmazie},
  number    = {12},
  doi       = {10.1002/ardp.202100260},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-256596},
  year      = {2021},
  abstract  = {In 1998, the aminoglycoside antibiotic gentamicin sulfate caused several cases of deaths in the United States, after the switch from twice- to once-daily application. Endotoxins were discussed as the cause for the adverse effects and sisomicin was identified as the lead impurity; batches containing sisomicin were contaminated with more impurities and were responsible for the fatalities. In 2016, anaphylactic reactions in horses, and later in humans with one fatality, were observed after application of gentamicin sulfate contaminated with histamine. To determine whether histamine was responsible for the 1990s death cases as well, histamine was quantified by means of liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 30 samples of gentamicin sulfate analyzed in previous studies. Furthermore, a relative quantification of sisomicin was performed to check for a correlation between histamine and the lead impurity. A maximum amount of 11.52 ppm histamine was detected, which is below the limit for anaphylactic reactions of 16 ppm, and no correlation of the two impurities was observed. However, the European Medicines Agency recommends a stricter limit with regard to the maximum single dose of gentamicin sulfate to reach a greater gap between the maximum histamine exposition of 4.3 µg and the quantity known to cause hypotension of 7 µg. The low amounts of histamine and the fact that there is no connection with the contamination with sisomicin showed that histamine was not the cause for the death cases in the United States in 1998, and endotoxins remain the most probable explanation.},
  language  = {en}
}
@phdthesis{Muelek2015,
  author    = {M{\"u}lek, Melanie},
  title     = {Distribution and metabolism of constituents and metabolites of a standardized maritime pine bark extract (Pycnogenol®) in human serum, blood cells and synovial fluid of patients with severe osteoarthritis},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-128085},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2015},
  abstract  = {Dietary polyphenols have been related to beneficial effects on humans' health. Pycnogenol®, a dietary polyphenol-rich food supplement complies with the monograph "Maritime pine extract" in the United States Pharmacopeia (USP) and has demonstrated effects in different diseases. Several human trials concerning knee osteoarthritis have shown significant improvement of the symptoms like reducing the pain and the stiffness of the joint(s) upon intake of Pycnogenol®. After oral intake of multiple doses of Pycnogenol® previously low concentrations in the nanomolar range of monomeric extract constituents have been found in human plasma as well as a bioactive metabolite, δ-(3,4-dihydroxy-phenyl)-γ-valerolactone (M1), which is formed by the human intestinal flora from the procyanidins' catechin units. It is not clear yet which compound(s) of the complex extract is (are) mainly responsible for the described clinical effects of Pycnogenol®. To gain deeper insights into the in vivo fate of the pine bark extract the distribution of its constitutents and metabolites was closer investigated in the present thesis. Initial in vitro experiments suggested a facilitated cellular uptake of M1 into human erythrocytes, possibly via GLUT-1 transporter. For elucidating further the in vitro and in vivo metabolism of M1 in human blood cells, a metabolomic approach was performed using UPLC-ESI-qTOF-MSE analysis, which revealed a comprehensive and rapid metabolism of M1 to a variety of biotransformation products in human blood cells. Predominant metabolites were found to be conjugates of glutathione (GSH) isomers, namely M1-S-GSH and M1-N-GSH. Further sulfur-containing biotransformation products of M1 were conjugates with oxidized glutathione (M1-GSSG) and cysteine (M1-CYS) and the sulfated derivative of M1 (M1-sulfated). Other in vitro biotransformation products constituted the open-chained ester form of M1 (M1-COOH), hydroxybenzoic acid and the methylated (M1-methylated), acetylated (M1-acetylated), hydroxylated (M1-hydroxylated) and ethylated (M1-ethylated) derivatives of M1. Indeed, six of these in vitro metabolites, respectively M1-COOH, M1-sulfated, hydroxybenzoic acid, M1-S-GSH, M1-methylated and M1-acetylated, were also identified in vivo in blood cells of human volunteers after ingestion of Pycnogenol®. Related reference material was synthesized for reliable confirmation of the metabolites M1-GSH, M1-GSSG, M1-CYS and M1-COOH. In the course of a randomized controlled clinical trial patients suffering from severe osteoarthritis ingested multiple doses of 200 mg/day Pycnogenol® for three weeks before they were scheduled for an elective knee replacement surgery. Various biological specimen, respectively blood cells, synovial fluid and serum samples, were to be analyzed to investigate the distribution and disposition of possibly bioactive constituents and metabolites. Therefore, highly sensitive methods were developed using liquid chromatography tandem mass spectrometry (LC-MS/MS)- technology because of the expected low concentrations of the analytes in the related matrices. Initially, for each matrix different sample preparation techniques (protein precipitation, liquid-liquid extraction, solid phase extraction and useful combinations thereof) were compared to achieve maximum detection sensitivity of the analytes that were of highest interest, namely M1, ferulic acid and taxifolin. By comparing 32 various sample clean-up procedures in human serum, the highest recovery of the metabolite M1 was achieved using a liquid-liquid extraction with ethyl acetate and tert-butyl methyl ether at a serum pH-value of 3.2. A similar extraction method was also chosen for analyte detection in human synovial fluid after comparing 31 different sample preparation techniques. Whole blood or blood cells are difficult to handle because of their high viscosity and strong coloration. The QuEChERS (quick, easy, cheap, effective, rugged and safe) approach which was originally developed for the food safety and thus for the determination of pesticide residues in fruits and vegetables yielded the highest total recovery rate of M1 in human blood cells when assessing 18 different sample clean-up techniques. By applying the QuEChERS method for the first time for the simultaneous and highly sensitive quantification of selected polyphenols in human blood cells it was demonstrated that this fast and inexpensive technique can be applied in clinical fields for cleaning-up highly complex and thus challenging biological matrices. All developed methods for the different biological specimen were optimized to achieve maximum sensitivity of the target analytes. The determined lower limits of quantification (LLOQs) were sufficient for the quantification of the study samples. The LLOQs ranged from 113 pg/mL for taxifolin to 48 ng/mL for caffeic acid in blood cells and from 80 pg/mL for taxifolin to 3 ng/mL for caffeic acid in synovial fluid. In human serum the LLOQs even ranged down to 35 pg/mL for taxifolin and up to 8 ng/mL for caffeic acid. All analytical methods were subjected to a full validation according to current EMA and FDA guidelines and fulfilled those criteria, showing excellent performance and reliability of the developed and optimized methods. Serum, blood cells and synovial fluid samples of the osteoarthritis patients were all processed with an enzymatic incubation with ß-glucuronidase/sulfatase to hydrolyse conjugates (phase-II-metabolism) prior the actual sample preparation. Additionally, serum samples of the osteoarthritis patients were prepared without enzymatic hydrolysis to determine the individual degree of conjugation with sulfate and glucuronic acid of the analytes. All determined concentrations in the patients' samples were in the lower ng/mL range. Notably, highest total concentrations of the polyphenols were not detected in serum, in which the degree of analyte conjugation with sulfate and glucuronic acid ranged from 54.29 ± 26.77\% for catechin to 98.34 ± 4.40\% for M1. The flavonoids catechin and taxifolin mainly partitioned into blood cells, whereas the metabolite M1, ferulic and caffeic acid primarily resided in the synovial fluid. The concentration of M1 in the blood cells was low, however, this could be explained by the previously observed extensive and rapid intracellular metabolism in vitro. This was now supported by the in vivo evidence in samples of patients who received Pycnogenol® in which the open-chained ester form of M1 (M1-COOH) as well as the glutathione conjugate of M1 (M1-GSH) were identified, indicating that M1 does not accumulate in its original form in vivo. Possibly, a variety of bioactive metabolites exist which might play an important role for the clinical effects of Pycnogenol®. Although the study participants were requested to avoid polyphenol-rich food and beverages within the last two days before the blood samplings this was obviously difficult for most of the patients. Hence, no statistically significantly difference was observed in the mean polyphenol concentrations in serum, blood cells and synovial fluid between the intervention and the control group. Nevertheless, it was possible to identify marker compounds for Pycnogenol® intake under real life conditions with occasional or regular consumption of polyphenol-rich foods and beverages. Thereby, ferulic acid was found in serum samples exclusively after intake of Pycnogenol®, confirming that ferulic acid is a suitable marker of consumption of French maritime pine bark extract. Taxifolin was present in serum and synovial fluid exclusively in the intervention group indicating a role as further marker of Pycnogenol® intake. Taxifolin, ferulic acid and caffeic acid were detected in both serum and synovial fluid only in the intervention group. Moreover, the metabolite M1, taxifolin and ferulic acid were only detected simultaneously in all matrices (serum, blood cells and synovial fluid) after ingestion of Pycnogenol®. Thus, deeper insights into the distribution of bioactive constituents and metabolites of Pycnogenol® into serum, blood cells and synovial fluid after oral administration to patients with severe osteoarthritis were gained. The present study provides the first evidence that polyphenols indeed distribute into the synovial fluid of patients with osteoarthritis where they might contribute to clinical effects.},
  subject      = {Pycnogenol},
  language  = {en}
}
@article{KuhnGrippFliederetal.2015,
  author    = {Kuhn, Joachim and Gripp, Tatjana and Flieder, Tobias and Dittrich, Marcus and Hendig, Doris and Busse, Jessica and Knabbe, Cornelius and Birschmann, Ingvild},
  title     = {UPLC-MRM Mass Spectrometry Method for Measurement of the Coagulation Inhibitors Dabigatran and Rivaroxaban in Human Plasma and Its Comparison with Functional Assays},
  series = {PLOS ONE},
  volume    = {10},
  journal   = {PLOS ONE},
  number    = {12},
  doi       = {10.1371/journal.pone.0145478},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-136023},
  pages     = {e0145478},
  year      = {2015},
  abstract  = {Introduction The fast, precise, and accurate measurement of the new generation of oral anticoagulants such as dabigatran and rivaroxaban in patients' plasma my provide important information in different clinical circumstances such as in the case of suspicion of overdose, when patients switch from existing oral anticoagulant, in patients with hepatic or renal impairment, by concomitant use of interaction drugs, or to assess anticoagulant concentration in patients' blood before major surgery. Methods Here, we describe a quick and precise method to measure the coagulation inhibitors dabigatran and rivaroxaban using ultra-performance liquid chromatography electrospray ionization-tandem mass spectrometry in multiple reactions monitoring (MRM) mode (UPLC-MRM MS). Internal standards (ISs) were added to the sample and after protein precipitation; the sample was separated on a reverse phase column. After ionization of the analytes the ions were detected using electrospray ionization-tandem mass spectrometry. Run time was 2.5 minutes per injection. Ion suppression was characterized by means of post-column infusion. Results The calibration curves of dabigatran and rivaroxaban were linear over the working range between 0.8 and 800 mu g/L (r > 0.99). Limits of detection (LOD) in the plasma matrix were 0.21 mu g/L for dabigatran and 0.34 mu g/L for rivaroxaban, and lower limits of quantification (LLOQ) in the plasma matrix were 0.46 mu g/L for dabigatran and 0.54 mu g/L for rivaroxaban. The intraassay coefficients of variation (CVs) for dabigatran and rivaroxaban were < 4\% and 6\%; respectively, the interassay CVs were < 6\% for dabigatran and < 9\% for rivaroxaban. Inaccuracy was < 5\% for both substances. The mean recovery was 104.5\% (range 83.8-113.0\%) for dabigatran and 87.0\%(range 73.6-105.4\%) for rivaroxaban. No significant ion suppressions were detected at the elution times of dabigatran or rivaroxaban. Both coagulation inhibitors were stable in citrate plasma at -20 degrees C, 4 degrees C and even at RT for at least one week. A method comparison between our UPLC-MRM MS method, the commercially available automated Direct Thrombin Inhibitor assay (DTI assay) for dabigatran measurement from CoaChrom Diagnostica, as well as the automated anti-Xa assay for rivaroxaban measurement from Chromogenix both performed by ACL-TOP showed a high degree of correlation. However, UPLC-MRM MS measurement of dabigatran and rivaroxaban has a much better selectivity than classical functional assays measuring activities of various coagulation factors which are susceptible to interference by other coagulant drugs. Conclusions Overall, we developed and validated a sensitive and specific UPLC-MRM MS assay for the quick and specific measurement of dabigatran and rivaroxaban in human plasma.},
  language  = {en}
}
@phdthesis{JakobRodamer2014,
  author    = {Jakob-Rodamer, Verena},
  title     = {Development and validation of LC-MS/MS methods to determine PK/PD parameters of anti-infectives},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-109215},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2014},
  abstract  = {In the present thesis the development and validation of bioanalytical LC-MS/MS methods for the quantification of erythromycin A, erythromycin ethylsuccinate, roxithromycin, clarithromycin, 14 hydroxy clarithromycin, flucloxacillin, piperacillin and moxifloxacin in human plasma and human urine (piperacillin) is introduced. All methods were applied to analyze human plasma and urine samples from clinical trials and therefore, have been validated according to international guidelines. The methods were reliable in these studies and fulfilled all regulatory requirements known at the time of the study conduct. Moreover, the validation data of the macrolides were compared on three different mass spectrometers (API III Plus, API 3000™, API 5000™). The new innovations in the ion source (horizontal versus vertical electrospray), the ionpath (skimmer, QJet) and the diameter of the orifice resulted in better sensitivity and a larger linearity range for the majority of the analytes. Sensitivity was improved up to a factor of 12 (for clarithromycin) between API III Plus to API 3000™ and up to a factor of 8 (for erythromycin and roxithromycin) between API 3000™ and API 5000™, keeping the accuracy and precision data at about the same level. The high sensitivity was a benefit for example for the flucloxacillin study, because concentrations from all subject samples were detectable up to approximately eight half-lives, i.e. no concentrations needed to be reported below the quantification limit. Also the linearity range were extended from two orders of magnitude to up to four orders of magnitude, which increases the likelihood to allow to analyze all samples from a pharmacokinetic study in the same run. This is especially useful if a large concentration range needs to be analysed, for example, if the method shall be applied in an ascending dose study. Then, all low concentrations from the beginning of the study can be determined, as well as all high concentrations, without the need to dilute and analyse single samples repeatedly. The pharmacokinetic data were compared to previously reported literature data and correlated graphically with MIC values of popular microorganisms which might be a starting point for further PK/PD investigations. The PK/PD theory is a very helpful tool for prediction of the efficacy of given drugs against certain micro-organisms. Depending on the pharmacodynamic processes, e. g. the mode of action, three classes of drugs have been identified. In the same way this applies to adverse effects, which need to be minimised by reducing plasma concentrations. These coherences are not well-investigated, yet, and are not discussed further in this thesis. Still, a lot of research has to be done in this interdisciplinary field to minimise uncertainty in single values, like an AUC/MIC. These include: Improve accuracy and precision of bioanalytical methods determining total and free concentration data in biological matrices for calculation of AUC and Cmax These parameters are related to the MIC in pharmacodynamic considerations. Since the determination of the MIC often underlies significant variations and also differences between microbiological laboratories, the determination of concentrations of anti-infectives is particular important, being achievable by scientific exact techniques. Finally, from the volume of distribution of antibiotics can be used to derive information about intracellular concentrations and effectivity of antiinfectives.},
  subject      = {Antimikrobieller Wirkstoff},
  language  = {en}
}
@phdthesis{Rodamer2011,
  author    = {Rodamer, Michael},
  title     = {Development of practice-oriented LC-MS/MS methods for the determination of important drugs and their application for building PK/PD concepts},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-70809},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {In this thesis eight robust and reliable LC-MS/MS methods were developed and validated to analyze atorvastatin, clopidogrel, furosemide, itraconazole, loratadine, naproxen, nisoldipine and sunitinib in human plasma. The active metabolites 2-hydroxyatorvastatin, 4-hydroxyatorvastatin, hydroxyitraconazole, descarboethoxy-loratadine, 4-hydroxynisoldipine and N-desethylsunitinib were also included in the corresponding methods. Due to the different physical, chemical and pharmacokinetic properties of the analytes a wide spectrum regarding sample preparation techniques, chromatography and mass spectrometric detection was covered. Protein precipitation methods were developed for furosemide, itraconazole, naproxen, nisoldipine and sunitinib. Liquid-liquid extraction methods were developed for atorvastatin, clopidogrel and loratadine. Criteria to choose protein precipitation or liquid-liquid extraction were the final plasma concentrations of the drugs, which are mainly dependant on the dose, bioavailability and t1/2 and of course cost-effectiveness. Altogether, the methods have a concentration range from 0.001 ng/mL (LLOQ of clopidogrel) to 50000 ng/mL (highest calibration point for naproxen), covering 5 x 107 orders of magnitude. The runtime of the methods ranged from 2 to 4 minutes, facilitating a high sample throughput. All developed methods were validated according to recent guidelines as they were used to analyze sampes from clinical trials. Excellent linearity, intra-day and inter-day precision and accuracy were observed in the validated calibration ranges. Hemolyzed, lipemic and different batches of human plasma as well as sample dilution did not affect the determiantion of the analytes. Clopidogrel, loratadine, nisoldipine and sunitinib and if available their metabolites were subjected to a matrix effect test, resulting in no influence of different batches of human plasma on the analytical methods. Noteworthy is clopidogrel that shows a slight effect on one of the two used mass spectrometers. However, that effect was reproducible and did therefore not affect clopidogrel determination. No evidence of instability during chromatography, extraction and sample storage processes for all analytes except 4-hydroxyatorvastatin was found, for which a significant decrease was observed after three months. During incurred sample reanalysis of study samples 95 \% of the samples were within ±15 \% with respect to the first analysis. Moreover, the atorvastatin, loratadine and clopidogrel method were compared on two generations of triple quadrupole mass spectrometers, the API 3000™ and the API 5000™. The new ion source and the changes in the ion path of the API 5000™ provided higher sensitivity, the extend depending on the substance. However, the API 3000™ had very good precision in the performed system comparison. The validated methods showed excellent performance and quality data during routine sample analysis of eight clinical trials. Moreover, they are suitable for high sample throughput due to their short run times.},
  subject      = {LC-MS},
  language  = {en}
}
@phdthesis{Vogl2011,
  author    = {Vogl, Silvia},
  title     = {Investigation of individual differences in the metabolic elimination of drugs by the polymorphic enzymes CYP2C9, 2C19 and 2D6 based on metabolite profiling by LC-MS/MS},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-67216},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {Mit der vorliegenden Studie sollte zu dem wichtigen Forschungsfeld der Pharmakogenetik beigetragen werden, indem zum einen eine einfache und sichere kombinierte Ph{\"a}notypisierung der drei zuvor erw{\"a}hnten CYPs (CYP2D6, CYP2C9 und CYP2C19) entwickelt, und zum anderen die Vorhersagekraft des Genotyps f{\"u}r den gemessenen Ph{\"a}notyp n{\"a}her untersucht werden sollte. Es ist uns gelungen eine sichere, einfache, schnelle und kombinierte Ph{\"a}notypisierung der beiden wichtigen Monooxygenasen CYP2D6 und CYP2C9 zu etablieren. Zun{\"a}chst wurden dazu Wechselwirkungsstudien mit den ausgew{\"a}hlten Testsubstanzen Dextromethorphan (DEX, CYP2D6), Flurbiprofen (FLB, CYP2C9) und Omeprazole (OME, CYP2C19) durchgef{\"u}hrt. Es konnte gezeigt werden, dass DEX und FLB als Kombination verabreicht werden k{\"o}nnen. Die Gabe von OME gemeinsam mit FLB ver{\"a}ndert jedoch das Ergebnis der CYP2C9 Ph{\"a}notypisierung. Dies ist eine neue Erkenntnis, denn noch 2004 wurde ein Ph{\"a}notypisierungscocktail ver{\"o}ffentlicht, der die Kombination von FLB und OME enthielt. Bei der genannten Studie wurden jedoch, unseres Wissens nach, keine Wechselwirkungsstudien zu den einzelnen Testsubstanz-Kombinationen durchgef{\"u}hrt. Die von uns entwickelte Ph{\"a}notypisierungsmethode wurde durch Wechselwirkungsstudien verifiziert. Sie ist jedoch auch in anderen Bereichen den bisher ver{\"o}ffentlichten ph{\"a}notypisierungscocktails {\"u}berlegen. Zum einen wurden nur sehr kleine Dosen sicherer Testsubstanzen verwendet. Dies wurde durch Entwicklung neuer, sensitiver LC-MS/MS Methoden erm{\"o}glicht. Zum anderen ist diese neue Prozedur schnell und nicht-invasiv durchf{\"u}hrbar. Nach Verabreichung der Testsubstanz muss der Urin nur f{\"u}r zwei Stunden gesammelt werden. Zudem weisen unsere Ergebnisse darauf hin, dass die normalerweise durchgef{\"u}hrte, aufwendige Glucuronidspaltung des CYP2D6 abh{\"a}ngigen DEX-Metaboliten, Dextrorphan, vermutlich vernachl{\"a}ssigt werden kann. Die wichtigsten Ergebnisse dieser Studie sind jedoch die Einblicke, die in die Vorhersagekraft der CYP2D6 und CYP2C9 Genotypen f{\"u}r die entsprechenden Ph{\"a}notypen gewonnen werden konnten. Fast 300 ph{\"a}notypisierte Kaukasier wurden auch in Hinsicht auf die wichtigsten varianten Allele von CYP2D6, CYP2C9 und CYP2C19 mithilfe bekannter und neu etablierter Methoden genotypisiert. Aufgrund der parallelen Ph{\"a}no- und Genotypisierung konnten Geno- und Ph{\"a}notyp direkt korreliert werden. Mit linearen Modellen war es m{\"o}glich, allen detektierten varianten CYP2D6- und CYP2C9-Allelen Aktivit{\"a}tskoeffizienten zuzuweisen. Diese k{\"o}nnen nun verwendet werden, um den Beitrag der einzelnen Allele zur resultierenden Enzymaktivit{\"a}t zu bestimmen, wodurch sich die Vorhersage dieser Aktivit{\"a}t ausgehend vom Genotyp verbessern lassen sollte. Besonders f{\"u}r CYP2D6 erm{\"o}glicht das neue Korrelationsmodel pr{\"a}zisere Vorhersagen des Ph{\"a}notyps als bisher ver{\"o}ffentlichte Modelle. Zusammengefasst leistet diese Studie durch die Entwicklung eines sicheren und einfachen Ph{\"a}notypisierungsprozesses f{\"u}r CYP2D6 und CYP2C9 und durch die Bestimmung von Aktivit{\"a}tskoeffizienten f{\"u}r alle einbezogenen CYP2D6 und CYP2C9 Allele und der damit verbundenen pr{\"a}ziseren Vorhersage des Ph{\"a}notyps ausgehend vom Genotyp einen wesentlichen Beitrag zum Forschungsfeld der Pharmakogenetik.},
  subject      = {Pharmakogenetik},
  language  = {en}
}