title: An indirect stereoselective analysis of nebivolol glucuronides in plasma by LC-MS/MS: Application to clinical pharmacokinetics.
abstract: Nebivolol is a racemate of the d-isomer responsible for β1adrenergic receptor antagonism and the l-isomer responsible for the release of nitric oxide from endothelial cells. Nebivolol is mainly metabolized to nebivolol glucuronide, which also contribute to the nebivolol β1adrenoreceptor antagonism. This study reports the development and validation of an indirect stereoselective method of analysis of nebivolol glucuronides in plasma by LC-MS/MS. The method was applied to the investigation of stereoselectivity in the glucuronidation of nebivolol in elderly hypertensive patients (n=11) CYP2D6 phenotyped as EM and treated with a single oral dose of the racemate. One-milliliter plasma aliquots spiked with internal standard (S)-(-)-metoprolol were incubated with 25μL of β-glucuronidase (final concentration 2500unit/mL) at pH 5.0 for 16h at 37°C. Linearity for total nebivolol was 0.2-125ng of each isomer per mL plasma and permitted analysis of nebivolol glucuronide isomers up to 48h after administration of a single oral dose of 10mg racemate. Regarding to the nebivolol glucuronide isomers, higher plasma concentrations of the d-isomer were observed compared to the l-isomer (d/l AUC=5.4), explaining at least in part the plasma accumulation of unchanged l-nebivolol (l/d AUC=1.8). This study also showed metabolic glucuronide nebivolol/unchanged nebivolol ratios of approximately 6.5 for the l-isomer (AUC 65.3 vs 10.1ngh/mL) and approximately 62.1 (335.2 vs 5.4ngh/mL) for the d-isomer. Considering that d-nebivolol glucuronide also contributes for β1adrenergic receptor antagonism, future studies regarding PK-PD of nebivolol should evaluate not only plasma concentrations of unchanged nebivolol isomers but also glucuronide nebivolol isomers.
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Carolina Pinto
authors.initials: CP
authors.lastname: Vieira
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Daniel Valente
authors.initials: DV
authors.lastname: Neves
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Evandro José
authors.initials: EJ
authors.lastname: Cesarino
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Rocha
authors.affiliation: Spécialité Conception & Développement, École de Biologie Industrielle, Cergy-Pontoise, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Poirier
authors.affiliation: Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. Electronic address: lanchote@fcfrp.usp.br.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Lanchote
mesh_terms: D002853:Chromatography, Liquid; D020719:Glucuronides; D006801:Humans; D000068577:Nebivolol / Q000737:chemistry*; D013237:Stereoisomerism; D053719:Tandem Mass Spectrometry
chemical_list: D020719:Glucuronides; D000068577:Nebivolol
keywords: Isomers; Metabolism; Nebivolol; Patient; Pharmacokinetics