Prediction of clinically relevant safety signals of nephrotoxicity through plasma metabolite profiling.

Addressing safety concerns such as drug-induced kidney injury (DIKI) early in the drug pharmaceutical development process ensures both patient safety and efficient clinical development. We describe a unique adjunct to standard safety assessment wherein the metabolite profile of treated animals is compared with the MetaMap Tox metabolomics database in order to predict the potential for a wide variety of adverse events, including DIKI. To examine this approach, a study of five compounds (phenytoin, cyclosporin A, doxorubicin, captopril, and lisinopril) was initiated by the Technology Evaluation Consortium under the auspices of the Drug Safety Executive Council (DSEC). The metabolite profiles for rats treated with these compounds matched established reference patterns in the MetaMap Tox metabolomics database indicative of each compound's well-described clinical toxicities. For example, the DIKI associated with cyclosporine A and doxorubicin was correctly predicted by metabolite profiling, while no evidence for DIKI was found for phenytoin, consistent with its clinical picture. In some cases the clinical toxicity (hepatotoxicity), not generally seen in animal studies, was detected with MetaMap Tox. Thus metabolite profiling coupled with the MetaMap Tox metabolomics database offers a unique and powerful approach for augmenting safety assessment and avoiding clinical adverse events such as DIKI.

Derivatization of 5-fluorouracil with 4-bromomethyl-7-methoxycoumarin for determination by liquid chromatography-mass spectrometry.

A robust new analytical method has been developed for the determination of 5-fluorouracil (5-FU) in human plasma samples using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The method is based on a liquid-liquid extraction procedure, precolumn derivatization, reversed-phase HPLC separation, and detection using atmospheric pressure chemical ionization and selected reaction monitoring. The derivatization agent used was 4-bromomethyl-7-methoxycoumarin. The internal standard for the assay procedure was a stable isotope labeled analog of 5-FU. The lower limit of quantitation was 1.0 ng/mL using 500 microL aliquots of plasma. Sample throughput on the mass spectrometer was approximately 17 samples/h (3.5 min/sample). The method was fully validated. The recovery of 5-FU averaged 76.1%. The accuracy of the assay, assessed from quality control samples, ranged from 99.1% to 104.3% (% theoretical). The overall interassay precision (% RSD) was 2.7%, and the intraassay precision (% RSD) ranged from 1.5% to 3.9%. The derivatized samples were found to be stable under sample analysis conditions and during refrigerator storage. The method was specific for the determination of 5-FU.

Dose-dependent inhibition of theophylline metabolism by disulfiram in recovering alcoholics.

The influence of disulfiram on theophylline metabolism was studied in 20 recovering alcoholics. Ten of the patients, who were selected at random, received 250 mg of disulfiram daily. The other 10 patients received 500 mg of disulfiram daily. Two single-dose studies of theophylline kinetics were performed--one as a baseline control and the other after 1 week of treatment with disulfiram. With disulfiram pretreatment, the plasma clearance of theophylline was decreased from 105.7 +/- 10.2 (mean +/- SEM) to 83.1 +/- 8.1 ml/kg per hour (p less than 0.001) in the 250 mg group and from 94.3 +/- 13.3 to 65.4 +/- 10.7 ml/mg per hour (p less than 0.001) in the 500 mg group. The elimination half-life was prolonged significantly in both groups. The percent reduction in theophylline clearance was greater in the 500 mg group (32.5 +/- 3.1; range, 21.6 to 49.6) than it was in the 250 mg group (21.2 +/- 1.7; range, 14.6 to 29.6; p less than 0.01). Disulfiram decreased the formation of all theophylline metabolites in smokers in both treatment groups. In each group, the hydroxylation pathway was affected more than the demethylation pathway. These data indicate that at therapeutic doses disulfiram exerts a dose-dependent inhibitory effect on theophylline metabolism. Depending on the dose of disulfiram, a dose reduction of theophylline by as much as 50% may be necessary to minimize the risk of toxicity.

Derivatization to improve thermospray HPLC/MS sensitivity for the determination of prostaglandins and thromboxane B2.

Derivatization of prostaglandins and thromboxane B2 using diethyl amino ethyl chloride and diethyl amino ethyl bromide improved thermospray HPLC/MS sensitivity. The derivatization was evaluated for prostaglandin A1, A2, D2, E2, F1 alpha, F2 alpha, and thromboxane B2. The derivatization reaction, thermospray operating conditions, and mode of detection were optimized to produce the most intense [M + H]+ or [M - H]- ions for the derivative. Derivatization was better than 99% complete in 1 hour at 75 degrees C. No thermal degradation of the prostaglandins was observed. Positive thermospray ionization proved the mode most sensitive, enabling detection from 10 to 300 pg of each prostaglandin under multiple ion detection. The thermospray spectra exhibited intense [M + H]+ ions for the derivative with a few fragment ions from sequential losses of water from the [M + H]+ ion. Detection of a prostaglandin metabolite in plasma over the concentration range from 3 ppm to 30 ppb was possible using this derivatization.

Determination of prostaglandins, and other metabolites of arachidonic acid by thermospray HPLC/MS using post column derivatization.

Thermospray HPLC/MS analysis of the metabolites of arachidonic acid proved to be sensitive and specific. The compounds included were hydroxy-fatty acids (5-HETE, 12-HETE, and 15-HETE) and prostaglandins PGD2, PGE2, PGF2 alpha, PGA2, PGA1, TXB2, and 6-Keto-PGF1 alpha. Thermospray HPLC/MS analysis allows for simultaneous monitoring of each compound without the need for additional sample preparation or derivatization. The thermospray spectra for the metabolites exhibited [M + NH4]+ ions and fragment ions because of sequential loss of equivalents of H2O. HPLC/MS showed detection limits in the 0.5 to 5 ng range when using multiple ion detection for most of the metabolites. Post-column derivatization of these metabolites using trimethylanilinium hydroxide (TMAH) to form the methyl esters is also presented. This derivatization resulted in a gain in ion current by a factor of 3-6 for most compounds while adding potential specificity to the analysis. The thermospray spectra of the derivatives were nearly identical to the spectra of the free acid except the peaks were incremented by 14 daltons due to the methyl ester formation. The derivatization of the carboxylic acid group proved to be complete under thermospray conditions producing the maximum ion current and causing no compromise in operation of the interface.

Substrate probes for the mechanism of aromatic hydroxylation catalyzed by cytochrome P-450: selectively deuterated analogues of warfarin.

Optically pure analogues of (R)- and (S)-warfarin selectively deuterated in either the 6-, 7-, or 8-position were prepared and incubated with microsomal preparations from either nontreated, phenobarbital-pretreated, or beta-naphthoflavone-pretreated male Sprague-Dawley rats. The amount of deuterium retained and the relative amount of hydroxylated product formed (6-, 7-, 8-, or 4'-hydroxywarfarin) from each of the six substrates for each of the treatments were determined by capillary gas chromatography-mass spectrometry. The degree of deuterium retention in all products from all substrates was largely independent of both absolute configuration and induction state. Conversely, the relative amounts of product formed were highly dependent upon both absolute configuration and induction state. These results suggest that all the hydroxylation reactions proceed through an addition rearrangement step prior to or in the absence of epoxide formation, which appears to be dictated by the nature of the heme-Fe3+-oxene complex. In contrast, the position of hydroxylation or regioselectivity appears to be primarily dependent upon the nature of the apoprotein.

A sensitive and specific stable isotope assay for warfarin and its metabolites.

A capillary gas chromatographic mass spectrometric method for the quantification of warfarin and its known metabolites from microsomal incubations is described. Deuterium labelled 4', 6-, 7- and 8-hydroxy warfarins are used as internal standards and the method has detection limits of 1 ng ml-1 with 20 ng ml-1 being the lower limit for accurate quantification.

A stable isotope assay for pseudoracemic warfarin from human plasma samples.

A pseudoracemic technique utilizing a seable isotope in one enantiomer was employed for the simultaneous determination of (R) and (S)-warfarin from plasma of human subjects. The assay includes high performance liquid chromatographic clean-up prior to mass spectral analysis to eliminate ion interferences from either co-administered drugs or contamination of the source. The assay is reliable, accurate and precise to within 5% at the submicrogram level.