title: Influence of body temperature on indinavir crystallization under loop of Henle conditions.
abstract: OBJECTIVE
  Indinavir is a protease inhibitor used in the therapy of HIV-1+ patients. It causes indinavir stone formation. It has been shown to precipitate in the loop of Henle (LH) at plasma concentrations (conc[P]) of approximately 8 mg/L. Those experiments were performed at room temperature. Given the influence of temperature on crystallization in general, and solubility of indinavir in particular, we repeated the experiments under physiological (body) temperature conditions.
  
  
  METHODS
  Test solutions contained indinavir concentrations of 100-750 mg/L at ionic strengths varying from 0 to 800 mM simulating conditions in the proximal tubule and the LH. Solutions were titrated with base (NaOH) to find the pH value where nucleation is initiated. Experiments were conducted at room temperature (20 degrees C) and repeated under constantly monitored (body) temperature (37 degrees C).
  
  
  RESULTS
  Experiments at 20 degrees C confirmed our previous results. At 37 degrees C, the relationship between pH and indinavir concentration remained inversely proportional. Again, the LH was confirmed as the most likely localization of crystallization. However, at 37 degrees C precipitation occurred at a lower urinary concentration (100 versus 125 mg/L) and within a lower pH range (6.67-7.26 versus 7.23-7.44). This lower urinary concentration corresponds to a lower conc[P] [critical value (CV)] of 6.41 mg/L, as compared with 8.01 mg/L at 20 degrees C.
  
  
  CONCLUSIONS
  The CV is even lower at 37 degrees C than previously assumed. Plasma peak concentration above the CV of 6.4 mg/L will induce crystallization in the LH and should be avoided.
authors.affiliation: Department of Experimental Urology, Erasmus Medical Centre, Dr Molenwaterplein, 3010 GD, Rotterdam, The Netherlands.
authors.forename: Saima
authors.initials: S
authors.lastname: Salahuddin
authors.forename: Dik J
authors.initials: DJ
authors.lastname: Kok
authors.forename: Noor N-P
authors.initials: NN
authors.lastname: Buchholz
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D001831:Body Temperature; D003460:Crystallization; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019469:Indinavir / Q000009:adverse effects* / Q000737:chemistry; D007669:Kidney Calculi / Q000139:chemically induced*; D008138:Loop of Henle / Q000378:metabolism*
chemical_list: D019380:Anti-HIV Agents; D019469:Indinavir