title: A high-throughput U-HPLC-MS/MS assay for the quantification of mycophenolic acid and its major metabolites mycophenolic acid glucuronide and mycophenolic acid acyl-glucuronide in human plasma and urine.
abstract: Mycophenolic acid (MPA) is used as an immunosuppressant after organ transplantation and for the treatment of immune diseases. There is increasing evidence that therapeutic drug monitoring and plasma concentration-guided dose adjustments are beneficial for patients to maintain immunosuppressive efficacy and to avoid toxicity. The major MPA metabolite that can be found in high concentrations in plasma is MPA glucuronide (MPAG). A metabolite usually present at lower concentrations, MPA acyl-glucuronide (AcMPAG), has been implicated in some of the adverse effects of MPA. We developed and validated an automated high-throughput ultra-high performance chromatography-tandem mass spectrometry (U-HPLC-MS/MS) assay using liquid-handling robotic extraction for the quantification of MPA, MPAG, and AcMPAG in human EDTA plasma and urine. The ranges of reliable response were 0.097 (lower limit of quantitation) to 200 μg/mL for MPA and MPAG and 0.156-10 μg/mL for AcMPAG in human urine and plasma. The inter-day accuracies were 94.3-104.4%, 93.8-105.0% and 94.4-104.7% for MPA, MPAG and AcMPAG, respectively. Inter-day precisions were 0.7-7.8%, 0.9-6.9% and 1.6-8.6% for MPA, MPAG and AcMPAG. No matrix interferences, ion suppression/enhancement and carry-over were detected. The total assay run time was 2.3 min. The assay met all predefined acceptance criteria and the quantification of MPA was successfully cross-validated with an LC-MS/MS assay routinely used for clinical therapeutic drug monitoring. The assay has proven to be robust and reliable during the measurement of samples from several pharmacokinetics trials.
authors.affiliation: Department of Anesthesiology, University of Colorado Denver, Aurora, CO 80045-7503, USA. jacek.klepacki@ucdenver.edu
authors.forename: Jacek
authors.initials: J
authors.lastname: Klepacki
authors.forename: Jelena
authors.initials: J
authors.lastname: Klawitter
authors.forename: Jamie
authors.initials: J
authors.lastname: Bendrick-Peart
authors.forename: Bjorn
authors.initials: B
authors.lastname: Schniedewind
authors.forename: Svenja
authors.initials: S
authors.lastname: Heischmann
authors.forename: Touraj
authors.initials: T
authors.lastname: Shokati
authors.forename: Uwe
authors.initials: U
authors.lastname: Christians
authors.forename: Jost
authors.initials: J
authors.lastname: Klawitter
mesh_terms: D002851:Chromatography, High Pressure Liquid / Q000379:methods*; D004355:Drug Stability; D020719:Glucuronides / Q000097:blood* / Q000652:urine*; D057166:High-Throughput Screening Assays / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000652:urine; D016018:Least-Squares Analysis; D057230:Limit of Detection; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000097:blood / Q000652:urine; D015203:Reproducibility of Results; D053719:Tandem Mass Spectrometry / Q000379:methods*; D014180:Transplantation
chemical_list: D020719:Glucuronides; D007166:Immunosuppressive Agents; C113145:mycophenolic acid glucuronide; D009173:Mycophenolic Acid