title: Pharmacokinetics of taurolidine following repeated intravenous infusions measured by HPLC-ESI-MS/MS of the derivatives taurultame and taurinamide in glioblastoma patients.
abstract: OBJECTIVE
  Taurolidine is known to have antimicrobial activity. Furthermore, at lower concentrations, it has been found to exert a selective antineoplastic effect in vitro and in vivo. The aim of this study was to investigate the pharmacokinetics of taurolidine in vivo following repeated intravenous infusion in a schedule used for the treatment of glioblastoma. As a prerequisite, the pharmacokinetics of taurolidine in human blood plasma and whole blood in vitro was investigated.
  
  
  METHODS
  The pharmacokinetics of taurolidine and its derivatives taurultame and taurinamide were investigated in human blood plasma and in whole blood in vitro using blood from a healthy male volunteer. During repeated intravenous infusion therapy with taurolidine, plasma samples were taken every hour for a period of 13 hours per day in seven patients (three male, four female; mean age 48.4 +/- 12.8 years, range 27-66 years) with a glioblastoma. Following dansyl derivatisation, the concentrations of taurultame and taurinamide were determined using a new method based on high-performance liquid chromatography (HPLC) online coupled to electrospray ionisation tandem mass spectrometry (ESI-MS/MS) in the multiple reaction monitoring mode. Under the experimental conditions used, taurolidine could not be determined directly and was back-calculated from the taurultame and taurinamide values.
  
  
  RESULTS
  The new HPLC-ESI-MS/MS method demonstrated high accuracy and reproducibility. In vitro plasma concentrations of taurultame and taurinamide remained constant over the incubation period. In whole blood in vitro, a time-dependent formation of taurinamide was observed. At the start of the incubation, the taurultame-taurinamide ratio (TTR) was 0.95 at an initial taurolidine concentration of 50 microg/mL, and 1.69 at 100 microg/mL. The concentration of taurultame decreased at the same rate as the taurinamide concentration increased, showing logarithmic kinetics. The calculated taurolidine concentration remained largely constant over the 6-hour incubation period. During repeated infusions in patients, calculated plasma concentrations of taurolidine showed a strong increase after the start of each infusion and continued to increase until the end of infusion, followed by a rapid decline. The TTR was found to fluctuate between 0.1 and 0.3, depending on the relation to the previous or next infusion period. The volume of distribution was markedly higher for taurolidine, taurultame and taurinamide than the plasma volume.
  
  
  CONCLUSIONS
  Taurolidine displayed a stable pattern of derivatives in plasma in vitro, whereas in whole blood, a time- and concentration-dependent conversion was apparent. In patients, the calculated average taurolidine plasma concentration, achieved with the repeated infusion regimen, was in the antineoplastic-effective concentration range. The tissue concentrations of taurolidine and taurultame are expected to be higher than the plasma concentrations, taking into account the calculated volumes of distribution. Repeated infusion of taurolidine is the therapeutically adequate mode of administration for the indication of glioblastoma.
authors.affiliation: Department of Neurosurgery, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. ruediger.stendel@charite.de
authors.forename: Ruediger
authors.initials: R
authors.lastname: Stendel
authors.forename: Louis
authors.initials: L
authors.lastname: Scheurer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schlatterer
authors.forename: Urs
authors.initials: U
authors.lastname: Stalder
authors.forename: Rolf W
authors.initials: RW
authors.lastname: Pfirrmann
authors.forename: Ingo
authors.initials: I
authors.lastname: Fiss
authors.forename: Hanns
authors.initials: H
authors.lastname: Möhler
authors.forename: Laurent
authors.initials: L
authors.lastname: Bigler
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000493:pharmacokinetics*; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D003499:Cyclic S-Oxides / Q000097:blood / Q000302:isolation & purification / Q000493:pharmacokinetics*; D004334:Drug Administration Schedule; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D021241:Spectrometry, Mass, Electrospray Ionization / Q000379:methods; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000302:isolation & purification / Q000493:pharmacokinetics; D013829:Thiadiazines / Q000008:administration & dosage / Q000097:blood / Q000302:isolation & purification / Q000493:pharmacokinetics*
chemical_list: D000970:Antineoplastic Agents; D003499:Cyclic S-Oxides; D013829:Thiadiazines; D013654:Taurine; C012566:taurolidine; C111424:taurultam; C111425:taurineamide