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Title: Major pitfalls in the measurement of artemisinin derivatives in plasma in clinical studies
Authors: N. Lindegardh
W. Hanpithakpong
B. Kamanikom
P. Singhasivanon
D. Socheat
P. Yi
A. M. Dondorp
R. McGready
F. Nosten
N. J. White
N. P.J. Day
Mahidol University
Nuffield Department of Clinical Medicine
National Center for Parasitology, Entomology and Malaria Control
Shoklo Malaria Research Unit
Keywords: Biochemistry, Genetics and Molecular Biology;Chemistry
Issue Date: 1-Dec-2008
Citation: Journal of Chromatography B: Analytical Technologies in the Biomedical and Life Sciences. Vol.876, No.1 (2008), 54-60
Abstract: A bioanalytical method for the analysis of artesunate (ARS) and its metabolite dihydroartemisinin (DHA) in human plasma using protein precipitation and liquid chromatography coupled to positive tandem mass spectroscopy was developed. The method was validated according to published US FDA-guidelines and showed excellent performance. However, when it was applied to clinical pharmacokinetic studies in malaria, variable degradation of the artemisinins introduced an unacceptable large source of error, rendering the assay useless. Haemolytic products related to sample collection and malaria infection degraded the compounds. Addition of organic solvents during sample processing and even low volume addition of the internal standard in an organic solvent caused degradation. A solid phase extraction method avoiding organic solvents eliminated problems arising from haemolysis induced degradation. Plasma esterases mediated only approximately 20% of ex vivo hydrolysis of ARS into DHA. There are multiple sources of major preventable error in measuring ARS and DHA in plasma samples from clinical trials. These various pitfalls have undoubtedly contributed to the large inter-subject variation in plasma concentration profiles and derived pharmacokinetic parameters for these important antimalarial drugs. © 2008 Elsevier B.V. All rights reserved.
ISSN: 15700232
Appears in Collections:Scopus 2006-2010

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