Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics

Neurocryptococcosis, a meningoencephalitis caused by Cryptococcus spp, is treated with amphotericin B (AmB) combined with fluconazole. The integrity of the brain-blood barrier and the composition of the cerebrospinal fluid (CSF) may change due to infectious and/or inflammatory diseases such as neuro...

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Autores principales:	Leandro Francisco Pippa, Maria Paula Marques, Anna Christina Tojal da Silva, Fernando Crivelenti Vilar, Tissiana Marques de Haes, Benedito Antônio Lopes da Fonseca, Roberto Martinez, Eduardo Barbosa Coelho, Lauro Wichert-Ana, Vera Lucia Lanchote
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	amphotericin B plasma unbound fraction urine cerebrospinal fluid LC-MS/MS Chemistry QD1-999
Acceso en línea:	https://doaj.org/article/948f2159669748fc9ead71c9e2a891ea
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spelling	oai:doaj.org-article:948f2159669748fc9ead71c9e2a891ea2021-12-01T12:47:31ZSensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics2296-264610.3389/fchem.2021.782131https://doaj.org/article/948f2159669748fc9ead71c9e2a891ea2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fchem.2021.782131/fullhttps://doaj.org/toc/2296-2646Neurocryptococcosis, a meningoencephalitis caused by Cryptococcus spp, is treated with amphotericin B (AmB) combined with fluconazole. The integrity of the brain-blood barrier and the composition of the cerebrospinal fluid (CSF) may change due to infectious and/or inflammatory diseases such as neurocryptococcosis allowing for the penetration of AmB into the central nervous system. The present study aimed to develop LC-MS/MS methods capable of quantifying AmB in CSF at any given time of the treatment in addition to plasma, plasma ultrafiltrate, with sensitivity compatible with the low concentrations of AmB reported in the CSF. The methods were successfully validated in the four matrices (25 μl, 5–1,000 ng ml−1 for plasma or urine; 100 μl, 0.625–250 ng ml−1 for plasma ultrafiltrate; 100 μl, 0.1–250 ng ml−1 for CSF) using protein precipitation. The methods were applied to investigate the pharmacokinetics of AmB following infusions of 100 mg every 24 h for 16 days administered as a lipid complex throughout the treatment of a neurocryptococcosis male patient. The methods allowed for a detailed description of the pharmacokinetic parameters in the assessed patient in the beginning (4th day) and end of the treatment with AmB (16th day), with total clearances of 7.21 and 4.25 L h−1, hepatic clearances of 7.15 and 4.22 L h−1, volumes of distribution of 302.94 and 206.89 L, and unbound fractions in plasma ranging from 2.26 to 3.25%. AmB was quantified in two CSF samples collected throughout the treatment with concentrations of 12.26 and 18.45 ng ml−1 on the 8th and 15th days of the treatment, respectively. The total concentration of AmB in plasma was 31 and 20 times higher than in CSF. The unbound concentration in plasma accounted for 77 and 44% of the respective concentrations in CSF. In conclusion, the present study described the most complete and sensitive method for AmB analysis in plasma, plasma ultrafiltrate, urine, and CSF applied to a clinical pharmacokinetic study following the administration of the drug as a lipid complex in one patient with neurocryptococcosis. The method can be applied to investigate the pharmacokinetics of AmB in CSF at any given time of the treatment.Leandro Francisco PippaMaria Paula MarquesAnna Christina Tojal da SilvaFernando Crivelenti VilarTissiana Marques de HaesBenedito Antônio Lopes da FonsecaRoberto MartinezEduardo Barbosa CoelhoLauro Wichert-AnaVera Lucia LanchoteFrontiers Media S.A.articleamphotericin Bplasmaunbound fractionurinecerebrospinal fluidLC-MS/MSChemistryQD1-999ENFrontiers in Chemistry, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	amphotericin B plasma unbound fraction urine cerebrospinal fluid LC-MS/MS Chemistry QD1-999
spellingShingle	amphotericin B plasma unbound fraction urine cerebrospinal fluid LC-MS/MS Chemistry QD1-999 Leandro Francisco Pippa Maria Paula Marques Anna Christina Tojal da Silva Fernando Crivelenti Vilar Tissiana Marques de Haes Benedito Antônio Lopes da Fonseca Roberto Martinez Eduardo Barbosa Coelho Lauro Wichert-Ana Vera Lucia Lanchote Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics
description	Neurocryptococcosis, a meningoencephalitis caused by Cryptococcus spp, is treated with amphotericin B (AmB) combined with fluconazole. The integrity of the brain-blood barrier and the composition of the cerebrospinal fluid (CSF) may change due to infectious and/or inflammatory diseases such as neurocryptococcosis allowing for the penetration of AmB into the central nervous system. The present study aimed to develop LC-MS/MS methods capable of quantifying AmB in CSF at any given time of the treatment in addition to plasma, plasma ultrafiltrate, with sensitivity compatible with the low concentrations of AmB reported in the CSF. The methods were successfully validated in the four matrices (25 μl, 5–1,000 ng ml−1 for plasma or urine; 100 μl, 0.625–250 ng ml−1 for plasma ultrafiltrate; 100 μl, 0.1–250 ng ml−1 for CSF) using protein precipitation. The methods were applied to investigate the pharmacokinetics of AmB following infusions of 100 mg every 24 h for 16 days administered as a lipid complex throughout the treatment of a neurocryptococcosis male patient. The methods allowed for a detailed description of the pharmacokinetic parameters in the assessed patient in the beginning (4th day) and end of the treatment with AmB (16th day), with total clearances of 7.21 and 4.25 L h−1, hepatic clearances of 7.15 and 4.22 L h−1, volumes of distribution of 302.94 and 206.89 L, and unbound fractions in plasma ranging from 2.26 to 3.25%. AmB was quantified in two CSF samples collected throughout the treatment with concentrations of 12.26 and 18.45 ng ml−1 on the 8th and 15th days of the treatment, respectively. The total concentration of AmB in plasma was 31 and 20 times higher than in CSF. The unbound concentration in plasma accounted for 77 and 44% of the respective concentrations in CSF. In conclusion, the present study described the most complete and sensitive method for AmB analysis in plasma, plasma ultrafiltrate, urine, and CSF applied to a clinical pharmacokinetic study following the administration of the drug as a lipid complex in one patient with neurocryptococcosis. The method can be applied to investigate the pharmacokinetics of AmB in CSF at any given time of the treatment.
format	article
author	Leandro Francisco Pippa Maria Paula Marques Anna Christina Tojal da Silva Fernando Crivelenti Vilar Tissiana Marques de Haes Benedito Antônio Lopes da Fonseca Roberto Martinez Eduardo Barbosa Coelho Lauro Wichert-Ana Vera Lucia Lanchote
author_facet	Leandro Francisco Pippa Maria Paula Marques Anna Christina Tojal da Silva Fernando Crivelenti Vilar Tissiana Marques de Haes Benedito Antônio Lopes da Fonseca Roberto Martinez Eduardo Barbosa Coelho Lauro Wichert-Ana Vera Lucia Lanchote
author_sort	Leandro Francisco Pippa
title	Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics
title_short	Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics
title_full	Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics
title_fullStr	Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics
title_full_unstemmed	Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics
title_sort	sensitive lc-ms/ms methods for amphotericin b analysis in cerebrospinal fluid, plasma, plasma ultrafiltrate, and urine: application to clinical pharmacokinetics
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/948f2159669748fc9ead71c9e2a891ea
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Sensitive LC-MS/MS Methods for Amphotericin B Analysis in Cerebrospinal Fluid, Plasma, Plasma Ultrafiltrate, and Urine: Application to Clinical Pharmacokinetics

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