title: Validating a faster method for reconstitution of Crotalidae Polyvalent Immune Fab (ovine).
abstract: BACKGROUND
  Reconstitution of CroFab(®) (Crotalidae Polyvalent Immune Fab [ovine]) lyophilized drug product was previously performed using 10 mL sterile water for injection followed by up to 36 min of gentle swirling of the vial. CroFab has been clinically demonstrated to be most effective when administered within 6 h of snake envenomation, and improved clinical outcomes are correlated with quicker timing of administration. An alternate reconstitution method was devised, using 18 mL 0.9% saline with manual inversion, with the goal of shortening reconstitution time while maintaining a high quality, efficacious product.
  
  
  METHODS
  An analytical study was designed to compare the physicochemical properties of 3 separate batches of CroFab when reconstituted using the standard procedure (10 mL WFI with gentle swirling) and a modified rapid procedure using 18 mL 0.9% saline and manual inversion. The physical and chemical characteristics of the same 3 batches were assessed using various analytic methodologies associated with routine quality control release testing. In addition further analytical methodologies were applied in order to elucidate possible structural changes that may be induced by the changed reconstitution procedure.
  
  
  RESULTS
  Batches A, B, and C required mean reconstitution times of 25 min 51 s using the label method and 3 min 07 s (a 88.0% mean decrease) using the modified method. Physicochemical characteristics (color and clarity, pH, purity, protein content, potency) were found to be highly comparable. Characterization assays (dynamic light scattering, analytical ultracentrifugation, LC-MS, SDS-PAGE and circular dichroism spectroscopy were also all found to be comparable between methods.
  
  
  CONCLUSIONS
  When comparing CroFab batches that were reconstituted using the labeled and modified methods, the physicochemical and biological (potency) characteristics of CroFab were not significantly changed when challenged by the various standard analytical methodologies applied in routine quality control analysis. Additionally, no changes in the CroFab molecule regarding degradation, aggregation, purity, structure, or mass were observed.
  
  
  CONCLUSIONS
  The analyses performed validated the use of the more rapid reconstitution method using 18 mL 0.9% saline in order to allow a significantly reduced time to administration of CroFab to patients in need.
authors.affiliation: BTG International, Blaenwaun Ffostrasol, Llandysul, Ceredigion, SA44 5JT Wales, UK. david.gerring@btgplc.com
authors.forename: David
authors.initials: D
authors.lastname: Gerring
authors.forename: Thomas R
authors.initials: TR
authors.lastname: King
authors.forename: Richard
authors.initials: R
authors.lastname: Branton
mesh_terms: D000818:Animals; D000997:Antivenins / Q000494:pharmacology*; D002853:Chromatography, Liquid; D002942:Circular Dichroism; D003435:Crotalid Venoms / Q000633:toxicity; D004339:Drug Compounding / Q000379:methods*; D004591:Electrophoresis, Polyacrylamide Gel; D005260:Female; D007140:Immunoglobulin Fab Fragments / Q000494:pharmacology*; D007155:Immunologic Factors / Q000494:pharmacology*; D051379:Mice; D012909:Snake Bites / Q000188:drug therapy; D012965:Sodium Chloride; D016896:Treatment Outcome
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007155:Immunologic Factors; D012965:Sodium Chloride