TY  - THES
A1  - Devine, Eric
T1  - Increased removal of protein bound uremic toxins through reversible modification of the ionic strength during hemodiafiltration
T1  - Erhöhte Elimination proteingebundener Urämietoxine durch reversible Modifikation der Ionenstärke während der Hämodiafiltration
N2  - A large number of metabolic waste products accumulate in the blood of patients with renal failure. Since these solutes have deleterious effects on the biological functions, they are called uremic toxins and have been classified in three groups: 1) small water soluble solutes (MW < 500 Da), 2) small solutes with known protein binding (MW < 500 Da), and 3) middle molecules (500 Da < MW < 60 kDa). Protein bound uremic toxins are poorly removed by conventional hemodialysis treatments because of their high protein binding and high distribution volume. The prototypical protein bound uremic toxins indoxyl sulfate (IS) and p-cresyl sulfate (pCS) are associated with the progression of chronic kidney disease, cardiovascular outcomes, and mortality of patients on maintenance hemodialysis. Furthermore, these two compounds are bound to albumin, the main plasma protein, via electrostatic and/or Van-der-Waals forces. The aim of the present thesis was to develop a dialysis strategy, based on the reversible modification of the ionic strength in the blood stream by increasing the sodium chloride (NaCl) concentration, in order to enhance the removal of protein bound substances, such as IS and pCS, with the ultimate goal to improve clinical patient outcomes. Enhancing the NaCl concentration ([NaCl]) in both human normal and uremic plasma was efficient to reduce the protein bound fraction of both IS and pCS by reducing their binding affinity to albumin. Increasing the ionic strength was feasible during modified pre-dilution hemodiafiltration (HDF) by increasing the [NaCl] in the substitution fluid. The NaCl excess was adequately removed within the hemodialyzer. This method was effective to increase the removal rate of both protein bound uremic toxins. Its ex vivo hemocompatibility, however, was limited by the osmotic shock induced by the high [NaCl] in the substituate. Therefore, modified pre-dilution HDF was further iterated by introducing a second serial cartridge, named the serial dialyzers (SDial) setup. This setting was validated for feasibility, hemocompatibility, and toxin removal efficiency. A better hemocompatibility at similar efficacy was obtained with the SDial setup compared with the modified pre-dilution HDF. Both methods were finally tested in an animal sheep model of dialysis to verify biocompatibility. Low hemolysis and no activation of both the complement and the coagulation systems were observed when increasing the [NaCl] in blood up to 0.45 and 0.60 M with the modified pre-dilution HDF and the SDial setup, respectively. In conclusion, the two dialysis methods developed to transitory enhance the ionic strength in blood demonstrated adequate biocompatibility and improved the removal of protein bound uremic toxins by decreasing their protein bound fraction. The concepts require follow-on clinical trials to assess their in vivo efficacy and their impact on long-term clinical outcomes.
N2  - Eine große Zahl von Stoffwechselprodukten akkumuliert im Blut urämischer Patienten mit Nierenversagen. Da diese Moleküle schädliche Wirkungen auf die biologischen Funktionen haben, werden sie als Urämietoxine bezeichnet. Man teilt sie in drei Gruppen ein: 1) kleine wasserlösliche Substanzen (MG < 500 Da), 2) kleine, proteingebundene Substanzen (MG < 500 Da), 3) Mittelmoleküle (500 Da < MG < 60 kDa). Proteingebundene Urämietoxine werden wegen ihrer starken Proteinbindung und ihres Verteilungsvolumen durch klassische Hämodialyseverfahrens nur schlecht entfernt. Die prototypischen proteingebundenen Urämietoxine Indoxylsulfat (IS) und p-Cresylsulfat (pCS) sind bei chronischen niereninsuffizienten Patienten mit dem Fortschreiten der Niereninsuffizienz, Herz-Kreislauf-Erkrankungen und der Mortalität verbunden. Außerdem sind diese beiden Toxine an Albumin, dem wichtigsten Plasmaprotein, durch elektrostatische und/oder Van-der-Waals-Kräfte gebunden. Das Ziel der vorliegenden Arbeit war es, ein Dialyseverfahren basierend auf einer reversiblen Modifikation der Ionenstärke im Blut durch Erhöhung der Natriumchlorid (NaCl)-Konzentration zu entwickeln, um die Entfernung von proteingebundenen Molekülen wie IS und pCS zu erhöhen und dadurch eine Verbesserung des klinischen Verlauf der Patienten zu erreichen. Die Erhöhung der NaCl-Konzentration ([NaCl]) sowohl in normalem als auch in urämischem menschlichem Plasma war geeignet, um den proteingebundenen Anteil von IS und pCS durch Schwächung ihrer Bindungsaffinität zu Albumin zu verringern. Die Erhöhung der Ionenstärke während einer modifizierten Prädilutions-Hämodiafiltration (HDF) konnte durch eine Erhöhung der [NaCl] in der Substitutionslösung umgesetzt werden; dabei wurde der NaCl-Überschuss innerhalb des Dialysators vollständig entfernt. Dieses Verfahren war effektiv, um die Entfernungsrate beider proteingebundenen Urämietoxine zu steigern; seine Ex-vivo-Hämokompatibilität war allerdings aufgrund des osmotischen Schocks infolge der hohen [NaCl] im Substituat begrenzt. Deshalb wurde eine Iteration der modifizierten Prädilutions-HDF durch Einbau eines zweiten, seriellen Dialysators vorgenommen, bezeichnet als serielles Dialysator System (SDial). Diese letzte Methode wurde dann bezüglich der Durchführbarkeit, der Hämokompatibilität und Toxinentfernung validiert. Durch das SDial-System konnte, verglichen mit der modifizierten Prädilutions-HDF, eine bessere Hämokompatibilität bei ähnlicher Wirksamkeit erzielt werden. Beide Methoden, modifizierte Prädilutions-HDF und SDial System, wurden abschließend in ein Tierdialysemodell mit Schafen transferiert, wobei eine zufriedenstellende Biokompatibilität demonstriert werden konnte. Beide, zur vorübergehenden Erhöhung der Ionenstärke im Blut entwickelten Dialyseverfahren zeigten bei zufriedenstellender Biokompatibilität eine verbesserte Entfernung proteingebundener Urämietoxine durch Reduktion ihrer proteingebundenen Fraktion. In einem nächsten Schritt sind klinische Studien erforderlich, die diese Konzepte bezüglich ihrer In-vivo-Wirksamkeit und ihrer langfristigen Wirkung auf den Krankheitsverlauf untersuchen.
KW  - Hämodiafiltration
KW  - Ionenstärke
KW  - Proteinbindung
KW  - Urämietoxine
KW  - Hämodialyse
KW  - Biokompatibilität
KW  - Ionic strength
KW  - protein binding
KW  - uremic toxin
KW  - hemodialysis
KW  - biocompatibility
KW  - Urämie
KW  - Toxin
KW  - Ionenstärke
KW  - Blut
Y1  - 2013
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-83583
ER  - 
TY  - JOUR
A1  - Devine, Eric
A1  - Krieter, Detlef H.
A1  - Rüth, Marieke
A1  - Jankovski, Joachim
A1  - Lemke, Horst-Dieter
T1  - Binding Affinity and Capacity for the Uremic Toxin Indoxyl Sulfate
JF  - Toxins
N2  - Protein binding prevents uremic toxins from removal by conventional extracorporeal therapies leading to accumulation in maintenance dialysis patients. Weakening of the protein binding may enhance the dialytic elimination of these toxins. In ultrafiltration and equilibrium dialysis experiments, different measures to modify the plasma binding affinity and capacity were tested: (i), increasing the sodium chloride (NaCl) concentration to achieve a higher ionic strength; (ii), increasing the temperature; and (iii), dilution. The effects on the dissociation constant K-D and the protein bound fraction of the prototypical uremic toxin indoxyl sulfate (IS) in plasma of healthy and uremic individuals were studied. Binding of IS corresponded to one site binding in normal plasma. K-D increased linearly with the NaCl concentration between 0.15 (K-D = 13.2 +/- 3.7 mu M) and 0.75 M (K-D = 56.2 +/- 2.0 mu M). Plasma dilution further reduced the protein bound toxin fraction by lowering the protein binding capacity of the plasma. Higher temperatures also decreased the protein bound fraction of IS in human plasma. Increasing the NaCl concentration was effective to weaken the binding of IS also in uremic plasma: the protein bound fraction decreased from 89% +/- 3% to 81% +/- 3% at 0.15 and 0.75 M NaCl, respectively. Dilution and increasing the ionic strength and temperature enhance the free fraction of IS allowing better removal of the substance during dialysis. Applied during clinical dialysis, this may have beneficial effects on the long-term outcome of maintenance dialysis patients.
KW  - protein binding
KW  - hemodialysis
KW  - human serum albumin
KW  - dialyzer membrane
KW  - P-cresyl sulfate
KW  - removal
KW  - dialysate
KW  - progression
KW  - clearance
KW  - kidney disease;
KW  - protein-bound solutes
KW  - chronic kidney-disease
KW  - ionic strength
KW  - uremic toxin
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117486
VL  - 6
IS  - 2
ER  - 
TY  - THES
A1  - Heinze, Andreas
T1  - Bestimmung des Ausmaßes der Proteinbindung von Arzneistoffen mittels automatisierter kontinuierlicher Ultrafiltration
T1  - Determination of the extent of the protein binding of drugs by means of automated continuous ultrafiltration
N2  - Das Ausmaß der Proteinbindung eines Arzneistoffs hat Auswirkungen auf eine Vielzahl pharmakokinetischer Parameter wie z.B. das Verteilungsvolumen, die Metabolisierung oder Ausscheidung. Da nur der freie, ungebundene Anteil eines Arzneistoffs durch bio-logische Membranen diffundieren kann, ist dieser direkt für die pharmakologische Wirkung verantwortlich. Lediglich diese ungebundenen und damit frei beweglichen Arzneistoffmoleküle sind also in der Lage, an Rezeptoren zu binden und damit einen Effekt auszulösen. Je größer der ungebundene Anteil eines Arzneistoffs ist, desto größer kann auch der Effekt sein, den er zu bewirken vermag. Wird nun diese freie Konzentration verändert, so kann sich demzufolge die Wirkintensität des Arzneistoffs verändern. Daraus folgt, dass die Kenntnis über die Proteinbindung speziell für die Dosisfindung eines Arzneistoffs unerlässlich ist. Diese Zusammenhänge veranschaulichen, welche Bedeutung das Ausmaß der Proteinbindung eines Arzneistoffs hat. Für die Bestimmung der Proteinbindung existiert eine Vielzahl von Methoden. Neben der klassischen Gleichgewichtsdialyse werden vor allem Ultrafiltrationstechniken angewendet. Neuere Verfahren stellen verschiedenste kapillarelektrophoretische Methoden dar. Allen Verfahren ist gemein, dass es sich um In-vitro-Methoden handelt. Als einzige In-vivo-Methode hat sich die Mikrodialyse etabliert. Die im Rahmen dieser Arbeit entwickelte Bestimmungsmethode für das Ausmaß der Proteinbindungen stellt eine kontinuierliche Variante der Ultrafiltration dar. Mit Hilfe des in dieser Arbeit beschriebenen Verfahrens ist es im möglich, mit einem einzigen Experiment Proteinbindungen über einen großen Bereich verschiedener Arzneistoff-Protein-Verhältnisse zu berechnen. Dadurch wird die Bestimmung schneller und auch kostengünstiger. Zusätzlich wurde dieses Verfahren teilweise automatisiert, d.h. die Versuche werden programmgesteuert durchgeführt und ein manuelles Eingreifen ist nur noch an wenigen Stellen eines Versuches notwendig. Die Messanlage zur kontinuierlichen Ultrafiltration wurde nach dem Vorbild der Anlage von Oehlmann aufgebaut und im Zuge dessen fortentwickelt. Herzstück ist die Messzelle aus Plexiglas. Sie besteht aus einem Ober- und einem Unterteil. In diesem befindet sich eine Vertiefung für die Rührscheibe. Beim Zusammenbau werden zwischen die beiden Teile die Filterunterstützung und eine Ultrafiltrationsmembran gelegt. Die Ultrafiltrationsmembran hält hierbei aufgrund ihrer Trenngrenze die Proteinmoleküle in der Messzelle zurück und lässt nur freie Arzneistoffmoleküle durch. Ein Dichtungsring sorgt dafür, dass die Zelle, nachdem sie in einem Gestell fixiert wurde, nach außen hin dicht abschließt. Während eines Versuches werden abwechselnd Arzneistofflösung und reine Pufferlösung durch die Messzelle gepumpt. Am Auslass der Ultrafiltrationszelle wird die Absorption gemessen, die zu Absorptions-Zeit-Diagrammen führen. Wird nun der gleiche Versuch durchgeführt, nachdem eine Proteinlösung in die Messzelle injiziert wurde, verschiebt sich diese Kurve aufgrund der Wechselwirkung zwischen Arzneistoff und Proteinlösung nach rechts. Die Fläche zwischen diesen beiden Kurven kann als Maß für die Proteinbindung herangezogen werden. Für die Auswertung der Versuche wird aus den Messdaten errechnet, wie viel Arzneistoff sich zu jedem Zeitpunkt des Versuchs in der Messzelle befunden hat und wie viel ungebunden vorlag und damit am Detektor messbar ist. Da die Konzentration an Arzneistoff in der Messzelle im Laufe eines Versuches kontinuierlich gesteigert wird, erhält man Bindungsdaten über einen weiten Bereich von Arzneistoff-Protein-Verhältnissen. In dieser Arbeit wurden sowohl Versuche mit Rinderserumalbumin (BSA) als auch mit humanem Serumalbumin (HSA) durchgeführt. Die Standardabweichungen der bestimmten Proteinbindungswerte steigen mit fallender Proteinbindung. Damit sind sie nach außen hin neutral und ihre Löslichkeit sinkt. Wie die Ergebnisse zeigen, konnte dennoch das Ausmaß der Proteinbindung für eine Reihe von Fluorochinolonen bestimmt werden. Zusätzlich wurden mit dem Oxazolidinon Linezolid und dem Ketolid Telithromycin weitere Antibiotika vermessen. Die Proteinbindungen aller untersuchten Arzneistoffe gegenüber HSA stimmen mit Daten aus der Literatur überein. Wie bereits erwähnt lassen sich hierbei kleine Abweichungen sowohl mit unterschiedlichen Bestimmungsmethoden als auch mit verschiedenen eingesetzten Proteinen erklären. Die Literaturdaten geben meist die Plasmaproteinbindung eines Arzneistoffes wider und die Messungen in der vorliegenden Arbeit wurden allesamt mit Albumin, sei es vom Mensch oder Rind, durchgeführt. Da jedoch neben dem Albumin auch noch weitere Bestandteile des Plasmas mit den Arzneistoffmolekülen wechselwirken können, sind unterschiedliche Proteinbindungen zu erwarten.
N2  - The extent of the protein binding of drugs influences many pharmacokinetic parameters such as the volume of distribution, the metabolism or excretion of a drug. Only the free and unbound fraction of a drug is capable to penetrate biological membranes and as a result, only this fraction is responsible for the pharmacological effect. Just these unbound and therefore mobile drug molecules are able to bind to receptors and cause a certain effect. The larger the free fraction of a drug, the stronger the effect which can be expected. Changes of the concentration of the free drug likely affect the intensity of the pharmacological response. Therefore, the knowledge about the extent of the protein binding is especially important for the finding of the dosage of a drug. All these points demonstrate the importance of the extent of the protein binding for a drug. There are many methods available for the determination of the extent of the protein binding. Besides the classical method of equilibrium dialysis, mainly ultrafiltration techniques are used. Among the new methods are various capillary electrophoretic methods. All methods have in common that they represent in-vitro methods. Only microdialysis has been established as an in-vivo method. Comparing binding data achieved by different methods is difficult because these data often vary a lot. The aim is to develop a method which measures under almost physiological conditions and which allows a fast and easy determination of the protein binding of a drug so that many experiments being carried out with a similar method can be compared. The method for the determination of the extent of the protein binding of drugs developed in this work utilizes continuous ultrafiltration. Using the method described in this work, with one single experiment protein binding data can be calculated over a wide range of drug-protein ratios. Therefore, the determination is faster and even cheaper. Additionally, this method was automated which means that experiments are mostly done by computer and a manual intervention is only necessary at a few points. The measuring system for continuous ultrafiltration is build up according to Oehlmann and was further developed. The heart of the system is the ultrafiltration cell made of acrylic glass. It consists of two parts, a bottom and a top part. The bottom part has a dent for the stirrer. In assembled state, a filter support and an ultrafiltration membrane is put between the two parts. The ultrafiltration membrane keeps the protein molecules inside the ultrafiltration cell due to its molecular weight cut-off. Only unbound drug molecules can pass the membrane. A gasket seals the cell when it is fixed tightly in a frame. During the steps of an experiment, a drug-buffer solution and a pure buffer solution are pumped alternatively through the cell. The absorbance is measured at the outlet side and absorbance-time curves are obtained. Repeating this experiment after injection of protein solution into the cell, gives a curve which is moved to the right due to the interaction between drug and protein. The area between both curves represents the degree of the extent of the protein binding. For evaluation of the data, the amount of drug in the cell and the amount of the detected unbound drug at every single time point is calculated. Since the concentration of the drug in the ultrafiltration cell is continuously increased throughout the experiment, binding data over a wide range of drug/protein ratios are calculated. During this work, measurements using bovine and human serum albumin were performed. Zlotos et al.42 and Oehlmann95 already showed that the determination of drugs with a high extent of the protein binding was easier than the determination of drugs with lower extents of protein binding. The standard deviations of the data increase with decreasing protein binding. Furthermore, the solubility of the drugs should be high enough. The difficulties in the experiments with some fluoroquinolones occur because they are zwitterionic under physiological conditions, thus they are neutral and their solubility is low. However, as the data shows, the extent of the protein binding of some fluoroquinolones could be determined. Additionally, more antibiotics including the new oxazolidinone linezolid and the macrolide telithromycin were determined. The protein binding of all examined drugs measured with HSA was in accordance to literature data. As described earlier, slight differences in the results may result from different methods or different proteins. In literature, mostly the binding towards human plasma is given and the experiments in this work were performed with human or bovine albumin. Apart from albumin, also other molecules of the plasma can interact with drug molecules and can therefore contribute to the whole binding constant. Therefore, different data could be easily expected.
KW  - Proteinbindung
KW  - Ultrafiltration
KW  - Chinolone
KW  - Antibiotika
KW  - protein binding
KW  - ultrafiltration
KW  - quinolones
KW  - antibiotics
Y1  - 2004
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-11277
ER  - 
TY  - JOUR
A1  - Schmidt, Sebastian
A1  - Holzgrabe, Ulrike
T1  - Do the enantiomers of ketamine bind enantioselectively to human serum albumin?
JF  - European Journal of Pharmaceutical Sciences
N2  - The binding of drugs to plasma proteins is an important process in the human body and has a significant influence on pharmacokinetic parameter. Human serum albumin (HSA) has the most important function as a transporter protein. The binding of ketamine to HSA has already been described in literature, but only of the racemate. The enantiomerically pure S-ketamine is used as injection solution for induction of anesthesia and has been approved by the Food and Drug Administration for the therapy of severe depression as a nasal spray in 2019. The question arises if there is enantioselective binding to HSA. Hence, the aim of this study was to investigate whether there is enantioselective binding of S-and R-ketamine to HSA or not. Ultrafiltration (UF) followed by chiral capillary electrophoretic analysis was used to determine the extent of protein binding. Bound fraction to HSA was 71.2 % and 64.9 % for enantiomerically pure R- and S-ketamine, respectively, and 66.5 % for the racemate. Detailed binding properties were studied by Saturation Transfer Difference (STD)-, waterLOGSY- and Carr-Purcell-Meiboom-Gill (CPMG)-NMR spectroscopy. With all three methods, the aromatic ring and the N-methyl group could be identified as the structural moieties most strongly involved in binding of ketamine to HSA. pK\(_{aff}\) values determined using UF and NMR indicate that ketamine is a weak affinity ligand to HSA and no significant differences in binding behavior were found between the individual enantiomers and the racemate.
KW  - protein binding
KW  - albumin
KW  - electrophoresis
KW  - nuclear magnetic resonance spectroscopy
KW  - ultrafiltration
KW  - enantioselectivity
Y1  - 2024
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-349791
VL  - 192
ER  - 
TY  - JOUR
A1  - Schmidt, Sebastian
A1  - Zehe, Markus
A1  - Holzgrabe, Ulrike
T1  - Characterization of binding properties of ephedrine derivatives to human alpha-1-acid glycoprotein
JF  - European Journal of Pharmaceutical Sciences
N2  - Most drugs, especially those with acidic or neutral moieties, are bound to the plasma protein albumin, whereas basic drugs are preferentially bound to human alpha-1-acid glycoprotein (AGP). The protein binding of the long-established drugs ephedrine and pseudoephedrine, which are used in the treatment of hypotension and colds, has so far only been studied with albumin. Since in a previous study a stereoselective binding of ephedrine and pseudoephedrine to serum but not to albumin was observed, the aim of this study was to check whether the enantioselective binding behavior of ephedrine and pseudoephedrine, in addition to the derivatives methylephedrine and norephedrine, is due to AGP and to investigate the influence of their different substituents and steric arrangement. Discontinuous ultrafiltration was used for the determination of protein binding. Characterization of ligand-protein interactions of the drugs was obtained by saturation transfer difference nuclear magnetic resonance spectroscopy. Docking experiments were performed to analyze possible ligand-protein interactions. The more basic the ephedrine derivative is, the higher is the affinity to AGP. There was no significant difference in the binding properties between the individual enantiomers and the diastereomers of ephedrine and pseudoephedrine.
KW  - protein binding
KW  - AGP
KW  - ultrafiltration
KW  - saturation transfer difference NMR
KW  - epitope mapping
KW  - ephedrine
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300848
VL  - 181
ER  - 
TY  - JOUR
A1  - Shah, Nirav R.
A1  - Bulitta, Jürgen B.
A1  - Kinzig, Martina
A1  - Landersdorfer, Cornelia B.
A1  - Jiao, Yuanyuan
A1  - Sutaria, Dhruvitkumar S.
A1  - Tao, Xun
A1  - Höhl, Rainer
A1  - Holzgrabe, Ulrike
A1  - Kees, Frieder
A1  - Stephan, Ulrich
A1  - Sörgel, Fritz
T1  - Novel population pharmacokinetic approach to explain the differences between cystic fibrosis patients and healthy volunteers via protein binding
JF  - Pharmaceutics
N2  - The pharmacokinetics in patients with cystic fibrosis (CF) has long been thought to differ considerably from that in healthy volunteers. For highly protein bound β-lactams, profound pharmacokinetic differences were observed between comparatively morbid patients with CF and healthy volunteers. These differences could be explained by body weight and body composition for β-lactams with low protein binding. This study aimed to develop a novel population modeling approach to describe the pharmacokinetic differences between both subject groups by estimating protein binding. Eight patients with CF (lean body mass [LBM]: 39.8 ± 5.4kg) and six healthy volunteers (LBM: 53.1 ± 9.5kg) received 1027.5 mg cefotiam intravenously. Plasma concentrations and amounts in urine were simultaneously modelled. Unscaled total clearance and volume of distribution were 3% smaller in patients with CF compared to those in healthy volunteers. After allometric scaling by LBM to account for body size and composition, the remaining pharmacokinetic differences were explained by estimating the unbound fraction of cefotiam in plasma. The latter was fixed to 50% in male and estimated as 54.5% in female healthy volunteers as well as 56.3% in male and 74.4% in female patients with CF. This novel approach holds promise for characterizing the pharmacokinetics in special patient populations with altered protein binding.
KW  - cystic fibrosis patients
KW  - healthy volunteers
KW  - cefotiam
KW  - beta-lactam antibiotics
KW  - population pharmacokinetics
KW  - protein binding
KW  - allometric scaling
KW  - body size
KW  - body composition
KW  - S-ADAPT
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196934
SN  - 1999-4923
VL  - 11
IS  - 6
ER  -