Rapid and simultaneous determination of mycophenolic acid and its glucuronide conjugate in human plasma by ion-pair reversed-phase high-performance liquid chromatography using isocratic elution.

A high-performance liquid chromatographic method has been developed for the simultaneous determination of mycophenolic acid (MPA) and its glucuronide conjugate (MPAG) in human plasma. The method involves protein precipitation with acetonitrile, followed by ion-pair reversed-phase chromatography on C18 column, with a 40 mM tetrabutyl ammonium bromide (TBA)-acetonitrile (65:35, v/v) mobile phase. A 20-microl volume of clear supernatant was injected after centrifugation, and the eluent was monitored at 304 nm. No interference was found either with endogenous substances or with many concurrently used drugs, indicating a good selectivity for the procedure. Calibration curves were linear over a concentration range of 0.5-20.0 microg/ml for MPA and 5-200 microg/ml for MPAG. The accuracy of the method is good, that is, the relative error is below 5%. The intra- and inter-day reproducibility of the analytical method is adequate with relative statistical deviations of 6% or below. The limits of quantification for MPA and MPAG were lower than 0.5 and 5.0 microg/ml, respectively, using 50 microl of plasma. The method was used to determine the pharmacokinetic parameters of MPA and MPAG following oral administration in a patient with renal transplantation.

Activated platelets enhance microparticle formation and platelet-leukocyte interaction in severe trauma and sepsis.

BACKGROUND: Activated platelets have been recently reported to produce platelet microparticles and to enhance platelet-leukocyte interaction. The precise role of platelets in systemic inflammatory response syndrome (SIRS) has not been clarified. The objective of this study was to evaluate microparticle formation and platelet-leukocyte interaction in severe trauma and sepsis. METHODS: Twenty-six patients with severe SIRS (SIRS criteria and serum C-reactive protein > 10 mg/dL) and 12 healthy volunteers were studied. The severe SIRS was caused by trauma in 12 patients and sepsis in 14. Microparticle formation, P-selectin expression on platelets, platelet-monocyte binding, and platelet-polymorphonuclear leukocyte (PMNL) binding were measured by flow cytometry in the presence or absence of ionomycin, N-formyl-methionyl-leucyl-phenylalanine, or anti-CD62p monoclonal antibody. Soluble P-selectin, thrombomodulin, neopterin, and PMNL elastase in blood were also measured. RESULTS: Microparticle formation, P-selectin expression on platelets, platelet-monocyte binding with or without ionomycin, and platelet-PMNL binding with ionomycin significantly increased in patients with severe SIRS in comparison with values in normal volunteers. The increased platelet-leukocyte binding in severe SIRS patients was markedly inhibited by P-selectin blockade and was not enhanced by N-formyl-methionyl-leucyl-phenylalanine. Soluble P-selectin, thrombomodulin, neopterin, and PMNL elastase in blood also increased in these patients. CONCLUSION: Activated platelets enhance microparticle formation and platelet-leukocyte interaction in severe trauma and sepsis. Enhanced platelet-leukocyte interaction is dependent on P-selectin expression and may be involved in the systemic inflammatory response after severe inflammatory insult.

Rapid and simple determination of mycophenolic acid in human plasma by ion-pair RP-LC with fluorescence detection.

Mycophenolic acid (MPA) is an immunosuppressive drug given as the prodrug of mycophenolate mofetil (MMF). In order to investigate the pharmacokinetics of MPA, a simple, specific, sensitive and reliable method has been established for the quantitative determination of MPA in plasma from renal transplant recipients. The method involves a single-step protein precipitation procedure and a specific determination by ion-pair reversed-phase high-performance liquid chromatography (HPLC) with fluorescence detection. Separation was achieved on a C18 column (150 x 4.6 mm, 5 microm) with a mobile phase composed of borate buffer (pH 10.0; 50 mM)--acetonitrile--tetrabutylammonium bromide (200 mM) (75:25:1, v/v/v). The fluorescence detector was set at 310 (excitation) and 430 nm (emission). Following protein precipitation with ice-cold acetonitrile, clear supernatants (50 microl) were injected into the HPLC system. The retention time of MPA was approximately 4.5 min. The HPLC run time was 8 min. The assay was linear in concentration range 0.2-20.0 microg/ml for MPA in human plasma. Precision of the assay in the concentration range examined was from 0.89 to 3.21% for the intra-assay run and from 3.01 to 4.35% for the inter-assay run. A limit of detection was 0.05 microg/ml at a signal-to-noise ratio of 3. This validated method was then applied to the determination of MPA concentrations in renal transplant recipients after oral administration of 0.75 g of MMF.

Analytic validation of the enzyme multiplied immunoassay technique for the determination of mycophenolic acid in plasma from renal transplant recipients compared with a high-performance liquid chromatographic assay.

The analysis of mycophenolic acid (MPA) has proved a valuable adjunct to the clinical care of organ transplant recipients. The analytic validation of the enzyme multiplied immunoassay technique (EMIT) for the determination of MPA in plasma is described. The EMIT MPA standard curve was 0 to 15.0 microg/mL, and curve storage was maintained for 4 weeks. The MPA EMIT assay proved reliable and reproducible, as shown by the intra-assay and interassay coefficients of variation (1.58-3.68% and 1.23-7.57%, respectively). Excellent linear correlation ( r = 0.999) was observed for dilution linearity. The sensitivity of the assay was 0.01 microg/mL. Recoveries of 99.4% to 104.2% were obtained by spiking aliquots of three controls of known MPA concentrations with MPA. No interference was observed for endogenous substances and coadministered immunosuppressant drugs, and no cross-reactivity from the major metabolite MPA glucuronide was found. The high-performance liquid chromatography (HPLC) assay used protein precipitation and C18 ion-pair chromatography with ultraviolet detection at 304 nm. Plasma concentrations of MPA were measured using EMIT and HPLC. A linear relationship was observed between EMIT and HPLC (EMIT = 1.091 x HPLC - 0.089; r 2 = 0.990, n = 129). These results indicate that EMIT is a simple, rapid, and sensitive assay method for the measurement of MPA in plasma.

Difference in the responses after administration of granulocyte colony-stimulating factor in septic patients with relative neutropenia.

OBJECTIVE: The objective of this study was to classify the clinical responses after administration of granulocyte colony-stimulating factor (G-CSF) in septic patients with relative neutropenia. PATIENTS AND METHODS: We administered recombinant human G-CSF (2 microg/kg) subcutaneously once a day for 5 days to 30 septic patients with white cell counts below 5,000 cells/mm3. Absolute neutrophil count (ANC), neutrophil differentiation, and serum concentration of G-CSF were determined serially. Bone marrow also was analyzed before and after treatment. RESULTS: Neutrophil responses to G-CSF varied from good (ANC > 10,000/mm3, group G, n = 20) to moderate (ANC < 10,000/mm3, group M, n = 5) to poor (no increase in ANC, group P, n = 5). Before G-CSF administration, the three groups showed no differences in ANC but did show significant differences in serum concentration of G-CSF. G-CSF concentration was 0.16 +/- 0.03 ng/mL in group G, 7.0 +/- 3.0 ng/mL in group M, and 270 +/- 90 ng/mL in group P. Immature neutrophils accounted for 35.0 +/- 3.7% of peripheral leukocytes in group P but only 5.1 +/- 0.6% in group G. Although bone marrow was depressed in all groups before G-CSF treatment, nucleated cell count increased significantly after rhG-CSF treatment in groups G and M. Survival rate after 4 weeks was 90% in group G and 100% in group M; no patient in group P survived. CONCLUSION: G-CSF administration was effective in septic patients with a low percentage of immature neutrophils and insufficient endogenous G-CSF. It had little effect on patients with a high percentage of immature neutrophils whose G-CSF production was up-regulated and whose bone marrow was severely depressed.

Granulocyte colony-stimulating factor ameliorates life-threatening infections after combined therapy with barbiturates and mild hypothermia in patients with severe head injuries.

OBJECTIVE: The objective of this study was to clarify the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) administration on infections in patients with severe head injuries after combined therapy with high-dose barbiturates and mild hypothermia. PATIENTS AND METHODS: Since 1996, we have administered rhG-CSF to eight patients with severe head injuries for 5 days (group G). Their treatment results were compared with those of 22 patients cared for earlier without rhG-CSF treatment (group N). All patients in both groups met the criteria of total leukocyte count (TLC) less than 5,000/mm3, C-reactive protein (CRP) over 10 mg/dL, and the presence of an infectious complication. Changes in the TLC, CRP, respiratory index, intracranial pressure, and infectious condition were evaluated in both groups. In addition, the nucleated cell count and differentiation from bone marrow aspiration, neutrophil functions, serum concentrations of interleukin-6, and plasma concentration of leukocyte elastase were evaluated in group G. RESULTS: In group G, TLC, nucleated cell count, and neutrophil functions significantly increased, whereas CRP, respiratory index, and interleukin-6 decreased reciprocally. There was no deterioration of intracranial pressure and leukocyte elastase. Consequently, seven of the eight patients in group G recovered from life-threatening infections, and none of the eight patients died. However, in group N, CRP and respiratory index remained high and TLC did not increase as much as it did in group G. Infections continued after 5 days in 17 of the 22 patients, 7 of whom died from severe infections during hospitalization. CONCLUSION: Administration of rhG-CSF ameliorated life-threatening infections without causing lung injury or increasing brain swelling in patients with severe head injuries who were treated with combined therapy involving high-dose barbiturates and mild hypothermia.

Priming, second-hit priming, and apoptosis in leukocytes from trauma patients.

BACKGROUND: Polymorphonuclear leukocytes (PMNL) play important roles in both host defenses and systemic inflammatory responses after insults. The objectives of this study are to examine the serial changes in PMNL priming and apoptosis in severely injured patients and to evaluate the impact of second hits on primed PMNL function and systemic vascular endothelial damage. METHODS: Twenty-four severely injured patients (mean Injury Severity Score, 31.1 +/- 9.7) were included. Infections were seen as second hits after trauma in seven patients. Oxidative activity, phagocytosis, and apoptosis of PMNL from serial blood samples were measured by flow cytometry. Oxidative activity with no stimulus and with formylmethionyl-leucyl-phenylalanine (FMLP) were analyzed as the priming index and FMLP response, respectively. Interleukin (IL)-6, IL-10, PMNL elastase, and thrombomodulin concentrations in blood were also measured before and after the second hit. RESULTS: The PMNL priming index was elevated from days 2 to 13, especially days 2 to 5 after injury. FMLP response was enhanced from days 2 to 21 after injury. Apoptosis of PMNL was inhibited for as long as 3 weeks after injury. Infections as second hits after trauma enhanced both the priming index and the FMLP response within 24 hours after diagnosis of infection and increased serum IL-6 concentrations. However, serum thrombomodulin levels were not affected by second hits. All patients with second hits survived. CONCLUSION: Severe trauma stimulated acute-phase priming in PMNL and inhibited apoptosis. Infections after trauma induced second-hit priming in PMNL, but the unchanged serum levels of thrombomodulin suggest that priming per se may not cause systemic vascular endothelial damage.

[Clinical usefulness of microparticle enzyme immunoassay for HBeAg and HBeAb in chronic hepatitis B patients].

A study was made of 73 samples from 6 chronic hepatitis B patients, 2 out of the 6 cases were non-treated and the 4 cases were interferon treated HBeAg, HBeAb, s-ALT and HBV-DNA. Detection of HBeAg and HBeAb were assayed by AxSYM system (Dainabot), which were based on microparticle enzyme immunoassay. 1) Fifty-three out of 73 samples showed positive for HBeAg; 45 samples showed only HBeAg positive (Group A) and 8 samples showed HBeAg and HBeAb positive (Group B). The positive ratios of HBV-DNA in each group 91.1% (41/45) and 50.0% (4/8), respectively and 4 out of the rest 20 samples that showed only HBeAb positive also showed HBV-DNA positive. The above 12 discrepant samples between HBeAg and HBV-DNA were collected from 4 chronic hepatitis B patients who became normal s-ALT levels after liver injury. The HBeAg S/N ratio (sample/negative control) of these samples were near the cutoff value (S/N = 2.1). 2) Comparing the movement between HBeAg and s-ALT levels in 6 chronic hepatitis B patients, the changes of HBeAg S/N ratio were related with the changes of s-ALT. The changes of HBeAg S/N ratio were observed before the movement of s-ALT. In conclusion, the detection of HBeAg/HBeAb by AxSYM system was useful to monitor the clinical course of chronic hepatitis B patients.

[Change of hepatitis B surface antigen in serum from patients with chronic hepatitis B].

To study the clinical significance of hepatitis B surface antigen (HBsAg) levels in chronic hepatitis B, sera from five patients with chronic hepatitis B HBsAg levels were measured quantitatively by counting immunoassay (CIA). CIA is an immunoassay that combines the latex agglutination method and particle counting technique. The results were as follow: 1) In four patients with chronic active hepatitis, the increases of HBsAg levels were earlier than that of alanine aminotransferase levels, and HBsAg levels had approximately the same changes as hepatitis B virus associated DNA polymerase (HBV DNA-p) activities. 2) In four patients treated with interferon-alpha or beta, HBsAg levels after treatment decreased in the same manner as HBV DNA-p activities. 3) In a patient with chronic inactivate hepatitis. HBsAg levels were the same changes as HBV DNA-p activities. These results suggested that quantitative analysis of HBsAg levels is useful to evaluate the prognosis and exacerbation for chronic hepatitis B.

Long-term follow-up of hepatitis B virus and hepatitis C virus replicative levels in chronic hepatitis patients coinfected with both viruses.

Dual infection with hepatitis B and C viruses is often encountered in endemic areas of both viruses. However, understanding of the clinical and virological implications is limited. The aim of this study was to investigate the role of each virus in liver injury and the interaction between the two viruses in dual infection with hepatitis B and C viruses. Three patients who had chronic infection with both hepatitis B and C viruses were examined, and a longitudinal study of both serum hepatitis B virus DNA and hepatitis C virus RNA levels over 4 years was undertaken. The results were correlated with serum alanine aminotransferase levels. Serum alanine aminotransferase values showed a relationship with hepatitis B virus replicative levels, but not with hepatitis C virus replicative levels in all 3 patients. Serial changes of replicative levels of both viruses were studied, and it was found that hepatitis C virus replicative levels were enhanced after the decline of hepatitis B virus replication in 1 of the 3 patients. In the remaining 2 patients, a transient rise of hepatitis C virus replicative levels in association with a decrease of hepatitis B virus replication was also observed during part of the follow-up period. These findings indicate that hepatitis B virus may play a dominant etiological role in liver injury, and that a suppressive action between hepatitis B and C viruses may occur in dual infection with both viruses.

[Evaluation of gelatin particle agglutination method for detection of Treponema pallidum antibody].

Treponema pallidum hemagglutination (HA) is one of the most frequently used methods for the detection of Treponema pallidum (T. pallidum) antibodies. Recently, an innovative agglutination method using artificial carriers was newly developed, and is now available as a routine method. In order to compare the newly developed particle agglutination (PA) method (FUJIREBIO INC.) with the conventional HA method, T. pallidum antibody titers of numerous sera were measured by respective methods. In the stability study, reconstituted reagent was stable for at least three weeks. Sample inactivation (56 degrees C/30 min) demonstrated no effect on the test results. Among 800 sera, 132 (16.6%) positives (+), 633 (79.1%) negatives (-) and (4.3%) indeterminates (+) were obtained by HA method. Meanwhile, 144 (18.0%) positives (+), 627 (78.4%) negatives (-) and 29 (3.6%) indeterminates (+) were obtained by PA method. The correlation between PA and HA method was 97.8%, and the antibody titers obtained by PA method showed good correlation with HA method. Those samples which showed discrepancy between PA and HA method in the above study were further examined with fluorescent treponemal antibody-absorption (FTA-ABS) method. The results obtained from FTA-ABS method were almost consistent with those obtained from PA method. For respective syphilis patients in stage I and II, antibody titer was monitored by HA, PA and RPR method. The results indicated that changes in antibody titer obtained from PA method was approximately the same as the titer changes obtained from RPR method. Namely, PA method detected the presence of IgM earlier than HA method.(ABSTRACT TRUNCATED AT 250 WORDS)

[Development of ELISPOT assay for thyroid autoantibody-producing cells].

A new assay system for detection of thyroid-autoantibody-producing cells was developed. This assay is based on the ELISPOT method with antigen-coated nitrocellulose membranes in 96-well microfilter plates. This was more sensitive than conventional methods such as a radioimmunoassay and a passive agglutination method for detection of thyroid-autoantibody production. The coefficients of inter- and intra-assay variations for antibody-producing cells were less than 6.5%. Thus, this assay system can be used to analyse the thyroid-specific immunological abnormalities as a routine test.

Rapid screening for Staphylococcus aureus infection by measuring enterotoxin B.

We developed a simple, sensitive laser nephelometric assay (LNA) to detect circulating staphylococcal enterotoxin B (SEB). This assay yields the result within 2 h and needs no special treatment. Influence of protein A, a product generated by Staphylococcus aureus, was negligible in this assay. The levels of SEB in plasma were measured in 28 patients with and without S. aureus infection with the LNA. The levels of SEB in plasma increased significantly in patients with S. aureus infection. We also demonstrated that the levels of SEB in plasma were higher in patients with methicillin-resistant S. aureus infection than in patients with nonresistant staphylococcal infection. Our data indicate that LNA is a useful assay in the early diagnosis of methicillin-resistant S. aureus infection.

Rapid and specific method for the determination of vancomycin in plasma by high-performance liquid chromatography on an aminopropyl column.

A high-performance liquid chromatographic method has been developed for the quantitative analysis of vancomycin in plasma. The method involves protein precipitation with acetonitrile, followed by normal-phase chromatography on an aminopropyl column. The clear supernatant was injected after centrifugation, and the eluent was monitored at 240 nm. No interference was found either with endogenous substances or with many currently used drugs, indicating a good selectivity for the procedure. The standard curve was linear between 0.1 and 100 micrograms/ml, and the detection limit was 0.01 microgram/ml of plasma. The mean intra- and inter-assay coefficients of variation were 2.4 and 4.0%, respectively, in the 10-50 micrograms/ml range. Application of the method to the study of vancomycin pharmacokinetics in a rabbit after a single intravenous dose is also reported.

Improved high-performance liquid chromatographic determination of amphotericin B in human serum and plasma.

An improved reversed-phase high-performance liquid chromatographic procedure is described for the determination of Amphotericin B (AMB) in human serum and plasma. The procedure involves the addition of the internal standard, p-nitroaniline, to the sample (0.1 ml) followed by protein precipitation with acetonitrile. The supernatant is injected directly onto a C8 chromatographic column and eluted with an acetonitrile-aqueous 0.01 M sodium acetate buffer, pH 7.4, mobile phase. A spectrophotometric detector operated at 405 nm is used. Retention times for internal standard and AMB are 5.2 and 6.6 min, respectively. The assay standard curve is linear between 0.05-2.0 micrograms cm-3. Within- and between-run relative standard deviations (RSD) for high and low concentrations of the drug are less than 5.30%. Analytical recovery of added AMB in serum is 98.4-101.4%. Data obtained by microbiological assay correlated well (r = 0.936) with LC results. Some commonly co-administered drugs and high concentrations of bilirubin are shown not to interfere.