Research Collection
Doctoral Thesis
Development of chromatographic methods and their applications for the analysis of chiral drug metabolism by enzymes altered during pregnancy
Author(s): Korner-Wyss, Sara
Publication Date: 2015
Permanent Link: https://doi.org/10.3929/ethz-a-010361935
Rights / License: In Copyright - Non-Commercial Use Permitted
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ETH Library DISS. ETH NO. 22444
DEVELOPMENT OF CHROMATOGRAPHIC METHODS AND THEIR APPLICATIONS FOR THE ANALYSIS OF CHIRAL DRUG METABOLISM BY ENZYMES ALTERED DURING PREGNANCY
A thesis submitted to attain the degree of DOCTOR OF SCIENCES of ETH Zurich
(Dr. sc. ETH Zurich)
presented by
SARA KORNER-WYSS
Msc ETH Pharm. Sc, ETH Zurich
born on 25.02.1981
citizen of Bern
accepted on the recommendation of
Prof. Dr. Karl-Heinz Altmann, examiner Prof. Dr. Ursula Quitterer, co-examiner Dr. Irmgard A. Werner, co-examiner
2015
An expert is a person who has made all the mistakes that can be made in a very narrow field. Niels Bohr (1885-1962)
Dank
Ich bedanke mich herzlich bei allen, die mich in den letzten Jahren unterst¨utzthaben und zum Gelingen dieser Arbeit beigetragen haben.
Ganz besonders bedanke ich mich bei Herrn Prof. Karl-Heinz Altmann f¨urdas Vertrauen und die M¨oglichkeit unter seiner Leitung zu promovieren. Frau Prof. Ur- sula Quitterer bin ich sehr dankbar, dass sie bereit war das Korreferat f¨urdiese Arbeit zu ¨ubernehmen. Frau Dr. Irmgard A. Werner danke ich herzlich, dass sie mir die M¨oglichkeit gegeben hat in ihrer Gruppe die Doktorarbeit zu machen und sie in mir die Faszination zur Gaschromatographie wecken konnte. Ich bedanke mich f¨ur die Unterst¨utzungund Ratschl¨age,wenn ich nicht weiter wusste und daf¨ur,dass ich meine Arbeit mit grosser Unabh¨angigkeit ausf¨uhrendurfte. Ein weiteres Dankesch¨ongeht an die ¨ubrigeAnalytikgruppe mit Danielle L¨uthi, Ruth Alder und Philipp Manser, f¨urihre grosse Unterst¨utzung und Hilfe in allen Belangen sowie die interessanten Diskussionen. Zudem danke ich auch meinen Mas- terstudenten Luca Castelnovo, Hulda Brem und Angela Tschabold, die mit grossem Einsatz mein Projekt weitergebracht haben.
Auch der Firma Brechb¨uhler AG, davon insbesondere Urs Hofstetter, Benjamin Oberlin und Ren´eWaldner danke ich f¨urden stets prompten und hilfreichen tech- nischen Support. Wobei ich Urs herzlich f¨ur seine ausgezeichnete Unterst¨utzungbei GC Fragen und Problemen und die guten Tipps und Tricks danke. Der Firma BGB Analytik AG und davon im Speziellen Georg Hottinger und Bernhard Fischer danke ich f¨urszur Verf¨ugung stellen von zahlreichen chiralen S¨aulenund Material f¨urdie GC-Analysen.
Der Gruppe Radiopharmazie unter Prof. Roger Schibli spreche ich ebenfalls ein herzliches Dankesch¨onaus, da ich bei Seminaren, Vortr¨agenund anderen Gruppen- aktivit¨atenstets willkommen war und mich als einen erweiterten Teil dieser Gruppe f¨uhlendurfte. Dr. Selena Sephton danke ich f¨urdie gute Zusammenarbeit und dass ich bei chemischen Fragen ein offenes Ohr bei ihr fand. Auch bei PD Dr. Stefanie Kr¨amerbedanke ich mich f¨urdie Unterst¨utzungbei Fragen zu biopharmazeutischen Themen. Ausserdem danke ich Monica Langfritz f¨urihren IT-Support.
e Ganz herzlich danke ich auch der Mittagsrunde, die Dr. Cindy Fischer, Roger Slavik, Romana Meletta, Dr. Adrienne Herde, PD Dr. Stefanie Kr¨amer,Dr. Linjing Mu, Claudia Keller, Dr. Thomas Betzel und Silvan Boss einschliesst, f¨urdie vielen guten und motivierenden Gespr¨ache ¨uber wissenschaftliche, aber auch allt¨agliche Themen und nat¨urlich auch f¨urdie auflockernden Abenden und Unternehmungen.
Ein zus¨atzlicher grosser Dank geht an meine Familie, meine Freunde, das gesamte T¨odi-Apotheke Team, und ganz speziell an meinen Malala Lukas Korner. F¨urihre Unterst¨utzung,Geduld und Aufmunterung zu jeder Zeit bin ich sehr dankbar. Abstract
During pregnancy, the female body undergoes important changes not only anatomi- cally, but also physiologically. These changes can lead to alterations in drug response and drug metabolism or even the emergence of new biological targets. Due to the scarcity of pharmacokinetic and pharmacodynamic data on newer and particularly chiral drugs, mainly ”old drugs” are used during gestation, even though these com- pounds are not often the first choice treatment. In light of this situation, in vitro methods for the assessment of chiral drug metabolism during pregnancy is of significant interest and importance. With newly developed gas chromatographic (GC) methods for chiral and also non-chiral ap- plications, separation of drug enantiomers and their metabolites were successfully performed. Two model compounds, with poor knowledge of safe use in pregnancy, were selected to establish in vitro methods, methylphenidate (MPH), a commonly used drug for the treatment of the attention deficit hyperactivity disorder (ADHD) in children and adults, and tramadol (TMD), a weak µ-receptor agonist for the treatment of moderate-severe pain. Both compounds are commercially available as racemic mixtures. For a few years, methylphenidate is also approved in enantiomeric form. Because samples with high water content or improper handling of chiral GC columns rapidly lead to column impairment and unreliable results, an option for chiral GC column state and performance check was needed. Since no test mixture for such conditions was available, a new chiral test mixture for cyclodextrin based (CD) stationary phases with versatile applicability was developed. The mixture consists of twelve enantiomer pairs with different functional groups and was tested on 14 chiral CD-columns. Successful analysis was obtained and no co-elution of any compound was observed. Generally best enantiomeric separation was achieved with β-CD capillary columns. Thereof, on one column all enantiomers were separated (BGB-176SE, BGB Analytics). On the column Beta DexTM 325 (Supelco), besides methylphenidate, every enantiomer pair was separated. On other columns (α-, β-, γ-CD) at least one enantiomer pair was baseline separated (Rs ≥ 1.5). The elution of the enantiomers still occurred in random order. Since different mechanisms are responsible for chiral recognition on cyclodextrins, separation efficiency and elution order are difficult to predict. However, the two enantiomeric forms of γ-valerolactone showed the same elution order on all columns. It is assumed to be the result of a
i predominant inclusion-interaction with the cyclodextrin molecules. For automated, highly sensitive and robust detection and for quantitative anal- ysis of chiral drug molecules and their metabolites, new analytical protocols were established. Such a method consists of automated sample preparation coupled to GC-MSD procedures with large volume injections (LVI > 10 µL) and pre-column backflushing (BKF) for mild evaporation conditions. This allows the analysis of thermo-labile compounds like methylphenidate. Furthermore, the sample matrix with potential risk to contaminate the analytical column or disturbing the analysis, is removed with BKF and extends the column lifetime. Additionally, high boiling substances are analyzable with successful removal of solvent prior to reaching the analytical column and enhanced analyte sensitivity is obtained. This is of particular interest for chiral GC columns, susceptible to solvent-induced harm. Efforts to develop liquid chromatographic methods (HPLC) to complement the GC methods did not lead to advantages, because sensitivity and screening capability using the same method were reduced with HPLC. Automated sample preparation was performed using the miniaturized extraction method micro extraction by packed sorbent (MEPS), where total solvent volumes of about 1 mL and minimal analyte volumes of 10 µL allowed successful extractions from a broad range of different matrices like water or buffer (saliva, blood or plasma would also be possible). Sample preparation with MEPS was beneficial in analyte enrichment but also in exchange of solvent, since water has to be avoided for di- rect GC analyses. The resulting MEPS-LVI-BKF-GC-MSD methods for chiral and non-chiral applications exhibited high sensitivity for the model compounds methyl- phenidate and tramadol. Other compounds (amphetamine, ibuprofen, cocaine, pen- tobarbital, tolperisone) also were successfully analyzed with the same method and highly sensitive mass selective detection. With a set of enzymes, whose expression levels are known to be important dur- ing pregnancy (e.g. carboxylesterase, cytochrome P450 2D6, 3A4), the model com- pounds methylphenidate and tramadol were analyzed. Carboxylesterase 1 (CES1), a serine hydrolase, was in a first attempt investigated for stability and optimal activity conditions, which are already known for cytochrome P450 enzymes (CYP). In metabolic experiments with chiral MEPS-LVI-BKF-GC-MSD analysis, racemic methylphenidate (MPH) was mainly stereoselectively metabolized by CES1 to ri- talinic acid (RA), the predominant metabolite of MPH. Also esterification could be demonstrated by formation of the parent compound in presence of ritalinic acid, methanol and CES1. To our knowledge it is the first time to be demonstrated. Methylphenidate was just weakly metabolized by CYP2D6, but no metabolite for- mation was detected and no stereoselectivity could be determined. With CYP3A4 no metabolism was observed. Tramadol showed low CES1 mediated metabolism, but without the appearance of formed metabolites or stereopreference. In contrast, CYP2D6 or CYP3A4 mediated TMD metabolism was stereoselective and also for- mation of the metabolites O-desmethyltramadol (ODT, M1) by CYP2D6, which
ii is pharmacologically active, or N -desmethyltramadol (M2, NDT) by CYP3A4, an inactive metabolite, was detected. Also HPLC analyses demonstrated tendencies for same results. Concluding, a reduced metabolic risk is stated for a medical treatment with methylphenidate during pregnancy. Nevertheless, enantiomeric methylpheni- date and lowest effective doses are to be chosen, for minimal drug and metabolite exposition for the fetus and prevention of possible, but still unknown adverse events. Concerning tramadol, no long-term administration is recommended, because of in- creased formation of active metabolite M1 with risk for withdrawal symptoms in a newborn, due to up-regulated CYP2D6 expression. The development of these new chromatographic methods and in vitro protocols for enzymatic studies can now also be applied for other drug compounds of interest, since particularly for new drugs knowledge about safe use during pregnancy is not available. The obtained results contribute in making predictions about the risk of undesired metabolic effects during pregnancy for a particular drug molecule, and are to be considered as addition to follow-up studies after drug approval.
iii Zusammenfassung
W¨ahrendder Schwangerschaft ver¨andertsich der weibliche K¨orper nicht nur ana- tomisch, auch physiologische Ver¨anderungenfinden statt. Dies kann zu ungewohnten Medikamentenwirkungen oder einem ver¨andertenMetabolismus f¨uhren.Ein Wirk- stoff kann sogar an neue Zielstrukturen binden. Weil kaum Daten ¨uber die Verwen- dung und den Metabolismus von neueren und / oder chiralen Arzneistoffen w¨ahrend der Schwangerschaft zur Verf¨ugung stehen, werden in der Praxis vorwiegend alt- bew¨ahrte Arzneistoffe bei Schwangeren eingesetzt. Dies, obwohl diese Arzeneistoffe in vielen F¨allennicht die therapeutisch bevorzugten Molek¨uledarstellen. Mit diesem Hintergrund wird die Bedeutung der Notwendigkeit f¨ur in vitro- Methoden deutlich. In der vorliegenden Arbeit wurden neue gaschromatographische Methoden (GC) entwickelt, um Arzneistoffenantiomere auf chiralen S¨aulenzu tren- nen, zu identifizieren und zu quantifizieren. Zwei chirale Modell-Molek¨ule,deren Verwendung in der Schwangerschaft wenig belegt ist, wurden ausgew¨ahlt,um die in vitro-Methoden zu entwickeln. Methylphenidat (MPH) ist ein h¨aufig eingesetz- ter Arzneistoff f¨urdie Behandlung der Aufmerksamkeits-Defizit-Hyperaktivit¨atsSt¨o- rung (ADHS) bei Kindern und Erwachsenen. Tramadol (TMD) ist ein schwacher µ-Rezeptor Agonist, der f¨urdie Behandlung von mittelstarken bis starken Schmerzen eingesetzt wird. Beide Verbindungen sind in razemischer Form als Spezialit¨aterh¨alt- lich, das Methylphenidat seit einigen Jahren auch als enantiomerenreines Dexmethyl- phenidat. Weil Proben mit hohem Wasseranteil oder unsachgem¨asserGebrauch von chiralen S¨aulenrasch zu Einbussen bei der S¨aulentrennleistung und zu schwer repro- duzierbaren Resultaten f¨uhrt,wurde ein Mittel zur Uberwachung¨ des GC Systems ben¨otigt. Zudem stand keine geeignete Testmischung zur Verf¨ugung. Aus diesen Gr¨undenwurde eine neue Testmischung f¨urchirale Kapillar-GC-S¨aulenentwic- kelt, die aber auch f¨urnicht-chirale Zwecke eingesetzt werden kann. Die Mischung besteht aus zw¨olf Enantiomerenpaaren mit verschiedenen funktionellen Gruppen und wurde auf 14 chiralen GC Kappilars¨aulenmit Cyclodextrin-basierten (CD) sta- tion¨arenPhasen getestet (CSPs). Es wurde auf keiner S¨auleeine Koelution von zwei Substanzen beobachtet. Die erfolgreichsten Trennungen wurden im Allgemeinen mit β-CD-Kapillars¨aulenerreicht, wobei auf einer S¨aule alle Enantiomere getrennt eluierten (”BGB-176SE”, BGB Analytics). Auf der S¨aule”Beta DexTM 325” (Su- pelco) wurden, abgesehen von Methylphenidat, ebenfalls alle Enantiomere getrennt. Auf weiteren S¨aulen(α-, β-, γ-CD) waren mindestens ein Enantiomerenpaar basis-
iv liniengetrennt (Rs ≥ 1.5). Die Elution und Trennleistung der Enantiomere zeigten eine randomisierte Reihenfolge, weil verschiedene Mechanismen f¨ur die chirale Erken- nung mit Cyclodextrinen verantwortlich sind. Dennoch, γ-Valerolacton zeigte auf allen getesteten S¨aulendie gleiche Reihenfolge bei der Enantiomerenelution. Es wird angenommen dass γ-Valerolacton haupts¨achlich durch einen Einschluss-Komplex mit Cyclodextrin inter-agiert, und die ¨ubrigenMechanismen aus diesem Grund weniger bedeutend sind f¨urdie Enantiomerentrennung auf einer chiralen CD-GC- S¨aule. Um automatisierbare, hoch sensitive und zuverl¨assigeAnalysen von chiralen Arzneistoffen und deren Metaboliten f¨urquantitative und qualitative Zwecke durch- zuf¨uhren,wurden neue analytische Methoden entwickelt. Eine solche Methode baut sich auf durch automatisierte Probenaufbereitung und anschliessende GC- MSD-Analyse mit Gross-Volumen-Injektion (LVI > 10 µL) und Vors¨aulen-Back- flushing (BKF) auf, was schonende Verdampfunsbedingungen zur Folge hat. Da- durch k¨onnenauch thermolabile Substanzen wie Methylphenidat analysiert werden. Mit Hilfe von BKF wird das L¨osungsmittelunter milden Bedingugen abgetrennt, bevor es die analytische S¨auleerreicht. Zudem kann durch die Probenmatrix ent- fernt werden, welche die S¨aulebesch¨adigenoder die Messungen beeintr¨achtigen k¨onnte. Dadurch wird die Lebensdauer einer analytischen S¨auleverl¨angert. Auch h¨ohersiedende Substanzen k¨onnenmit diesem Verfahren analysiert werden und die Sensitivit¨atder Methode gegen¨uber den Analyten wird verbessert. Insbeson- dere f¨urchirale S¨aulenist Backflushing ein Vorteil, da diese S¨aulengegen¨uber verschiedenen L¨osungsmittelnempfindlich sind. Ans¨atze, um die GC Methode mit Fl¨ussigchromatogrphie (HPLC) zu erweitern, zeigten keine Vorteile, weil die Empfindlichkeit mit HPLC reduziert war und f¨urdie Modellsubstanzen je individu- elle Analysenmethoden ben¨otigtwurden. Die automatische Probenaufbereitung wurde mit MEPS (micro extraction by packed sorbent) durchgef¨uhrt.Mit dieser Methode k¨onnen Mikroextraktionen aus- gef¨uhrtwerden, die f¨urden gesamten Prozess ein maximales L¨osungsmittelvolumen von nur rund 1 mL ben¨otigen und Extraktionen aus Volumina bis zu 10 µL erlauben. MEPS kann f¨urverschiendene Probenmatrices verwendet werden, wie Puffer oder Wasser, jedoch auch K¨orperfl¨ussigkeiten (Speichel, Blut, Plasma) w¨arenverwend- bar. MEPS war n¨utzlich in der Anreicherung von Analyten und dem L¨osungsmittel- austausch, da Wasser f¨urdirekte gaschromatographische Messungen zu vermeiden ist. Die entwickelte MEPS-LVI-BKF-GC-MSD-Methode zeigte f¨urchirale und nicht- chirale Anwendungen eine hohe Sensitivit¨atf¨urdie Modellsubstanzen Methylpheni- dat und Tramadol, aber auch andere chirale Substanzen (Amphetamin, Ibuprofen, Kokain, Pentobarbital, Tolperison) wurden mit dieser Methode erfolgreich und mit hoher Sensitivit¨atanalysiert. Ausgew¨ahlteEnzyme, deren Expression w¨ahrendeiner Schwangerschaft als be- deutsam bekannt ist, wie etwa die Carboxylesterase oder Cytochrom P450 En- zyme 2D6 und 3A4, wurden verwendet, um die Modellmolek¨ulezu untersuchen.
v Carboxylesterase 1 (CES1) ist eine Serinhydrolase. Dieses Enzym wurde in er- sten Untersuchungen auf seine Stabilit¨atund Aktivit¨atbei verschiedenen Bedingun- gen getestet. F¨urCytochrom P450 Enzyme (CYP) waren solche Angaben bereits verf¨ugbar. In enzymatischen Experimenten mit anschliessender MEPS-LVI-BKF-GC-MSD Analyse, wurde razemisches Methylphenidat (MPH) durch CES1 stereoselektiv zu Ritalins¨aure(RA) abgebaut, dem Hauptmetaboliten von MPH. Enzymatische Ver- esterung konnte ebenfalls in vitro best¨atigt werden, indem aus Ritalins¨aurein Gegenwart von Methanol und CES1 die Ausganssubstanz Methylphenidat gebildet wurde. Gem¨assunsrem Wissen, wurde die enzymatische Bildung von Methylphenidat aus Ritalins¨aurebisher noch nicht beschrieben. Durch das Enzym CYP2D6 wurde MPH nur schwach metabolisiert und kein Metabolit konnte detektiert werden, wie auch keine enantioselektive Tendenz f¨urden CYP2D6 Metabolismus beobachtet werden. Auch f¨urCYP3A4 konnte kein Metabolismus mit MPH festgestellt wer- den. Tramadol zeigte schwachen CES1-Metabolismus, jedoch ohne Detektion von Metaboliten oder einer enantioselektiven Tendenz. Dagegen wurden f¨urdie En- zymversuche mit CYP2D6 und 3A4 Stereopr¨aferenzenund Metaboliten detektiert. Tramadol, inkubiert mit CYP2D6, zeigte eine deutliche Bildung von O-Desmethyl- tramadol (ODT, M1), dem aktiven Metaboliten von Tramadol. Inkubation mit CYP3A4 erlaubte die Bildung von N-Desmethyltramadol (NDT, M2), einem inak- tiven Haptmetaboliten von Tramadol. Auch HPLC Analysen zeigten diese Tendenz. Aufgrund der Resultate darf angenommen werden, dass f¨urdie therapeutische An- wendung von Methylphenidat w¨ahrendder Schwangerschaft ein geringes metabolis- ches Risiko besteht. Dennoch sind, um allf¨alligeheute unbekannte Ereignisse zu vermeiden, die tiefst m¨oglichen effektiven Dosen zu w¨ahlenund ausschliesslich eine enantiomerenreine Formulierung, damit der F¨otuseiner geringen Arzneistoff- und Metaboliten-Konzentration ausgesetzt ist. Im Bezug auf Tramadol wird keine Lang- zeittherapie w¨ahrend der Schwangerschaft empfohlen, weil die Bildung von aktivem M1 Metaboliten erh¨oht ist, bedingt durch die st¨arkere Exprimierung von CYP2D6, und daher Entzugssymptome bei einem Neugeborenen erwartet werden m¨ussen. Die Entwicklung dieser chromatographischen Methoden und in vitro Protokolle f¨urmetabolische Studien k¨onnennun f¨urweitere Arzneistoffe verwendet werden, weil insbesondere bei neueren Arzneistoffen keine Informationen ¨uber eine sichere Ver- wendung w¨ahrendder Schwangerschaft verf¨ugbarsind. Die daraus resultierenden Informationen zu einem Arzneistoff unterst¨utzendie Voraussage zu unerw¨unschten metabolischen Arzneimittelwirkungen bei einer kurzzeitigen oder dauerhaften Ein- nahme w¨ahrendder Schwangerschaft. Trotzdem sind fortlaufende Studien zur Erken- nung von seltenen Ereignissen und zur Uberwachung¨ auch nach Zulassung eines Arzneimittels wie bis anhin unerl¨asslich.
vi Contents
1 Introduction1 1.1 Chirality - Same Things, but Different...... 1 1.2 Pregnancy...... 3 1.3 Pharmacokinetics and Pharmacodynamics...... 5 1.4 Enzymes and Metabolism...... 8 1.4.1 Cytochrome P450 Enzymes...... 9 1.4.2 Esterases and Hydrolases - Carboxylesterase...... 9 1.4.3 Conjugation Enzymes...... 10 1.5 Model Compounds Methylphenidate and Tramadol...... 12 1.5.1 Methylphenidate...... 12 1.5.2 Tramadol...... 16 1.6 Chromatography...... 20 1.6.1 Gas Chromatography...... 21 1.6.2 Liquid Chromatography...... 28 1.7 Sample Preparation...... 29
2 Aims and Scope 33
3 Results and Discussion 35 3.1 Monitoring of GC Systems...... 35 3.1.1 Test Mixture for Chiral Cyclodextrin Capillary GC Columns. 35 3.2 Method Development for Automated Sample Preparation and Chro- matography...... 45 3.2.1 MEPS Sample Preparation...... 46 3.2.2 Large Volume Injection with GC...... 48 3.2.3 Automated Sample Preparation and Large Volume Injection. 61 3.2.4 Chiral MEPS-LVI-BKF-GC...... 66 3.2.5 Derivatization for GC...... 71
vii 3.2.6 Liquid Chromatography...... 72 3.2.7 Stability Investigations...... 76 3.3 Enzyme Experiments...... 78 3.3.1 Stability and Performance Investigations on Carboxylesterase 78 3.3.2 Carboxylesterase Metabolism of Model Compounds...... 83 3.3.3 Cytochrome P450 Metabolism of Model Compounds..... 88
4 Conclusions and Outlook 92
5 Experimental Section 95 5.1 General Information...... 95 5.2 Identity of Methylphenidate and Tramadol...... 96 5.3 Chromatography...... 99 5.3.1 Gas Chromatography...... 99 5.3.2 HPLC-UV...... 101 5.3.3 Chromatographic Methods...... 102 5.3.4 Chiral Test Mixture...... 118 5.3.5 LVI-BKF-GC-MSD...... 125 5.3.6 MEPS-LVI-BKF-GC-MSD...... 125 5.3.7 Chiral LVI-BKF-GC-MSD...... 126 5.3.8 Chiral MEPS-LVI-BKF-GC-MSD...... 127 5.3.9 Derivatization for GC...... 128 5.3.10 Stability of Methylphenidate with Non-Chiral HPLC Analysis 129 5.3.11 Chiral Column Performance Test...... 130 5.3.12 Chiral HPLC of Methylphenidate...... 130 5.3.13 Chiral HPLC of Tramadol...... 131 5.4 Enzyme Experiments...... 132 5.4.1 Stability of CES...... 132 5.4.2 Methylphenidate Metabolism with CES and GC-MSD Analysis134 5.4.3 Methylphenidate Metabolism with CES and Chiral Chromato- graphic Analysis...... 134 5.4.4 Tramadol Metabolism with CES and Chiral Chromatographic Analysis...... 135 5.4.5 CYP2D6 Metabolism of Methylphenidate with Chiral Chro- matographic Analysis...... 135 5.4.6 CYP2D6 Metabolism of Tramadol with Chiral Chromatographic Analysis...... 136
viii 5.4.7 CYP3A4 Metabolism of Methylphenidate with Chiral Chro- matographic Analysis...... 137 5.4.8 CYP3A4 Metabolism of Tramadol with Chiral Chromatographic Analysis...... 138
Appendices 140 A HPLC Experiments...... 140 A.1 Saturation of MEPS BIN with 5x MEPS Sampling of TMD. 140 A.2 CES Metabolism of MPH and Chiral HPLC Analysis..... 141 A.3 CES Metabolism of TMD and Chiral HPLC Analysis..... 142 A.4 CYP2D6 Metabolism of MPH and Chiral HPLC Analysis... 142 A.5 CYP2D6 Metabolism of TMD and Chiral HPLC Analysis.. 143 A.6 CYP3A4 Metabolism of MPH and Chiral HPLC Analysis... 144 A.7 CYP3A4 Metabolism of TMD and Chiral HPLC Analysis.. 144
Bibliography 145
Publications 160
ix Lists of Abbreviations and Terms
abbreviation explanation L,W,d system size (length in cm, width, diameter) A drug fraction ACN acetonitrile ADHD attention/deficit hyperactivity disorder ADME pharmacokinetic processes of a drug in an organism, divided into absorption, distribution, metabolism and excretion AGP α1-glycoprotein (chiral HPLC column) Amm. Ac. buffer ammonium acetate buffer As symmetry factor ATR attenuated total reflection AUC area under the curve BBB blood brain barrier BGB-15 15% phenyl-, 85% methylpolysiloxane matrix by BGB Ana- lytics BGB-1701 14% cyanopropylphenyl -, 86% methylpolysiloxane matrix by BGB Analytics BIN barrel insert and needle of a MEPS syringe BKF backflush C concentration C2 modified silica stationary phase with an ethyl-side chain for LC or SPE C8 modified silica stationary phase with an octyl-side chain for LC or SPE C18 modified silica stationary phase with an octadecyl-side chain for LC or SPE CD cyclodextrin CES carboxylesterase CO cardiovascular output CSP chiral stationary phase CYP cytochrome P-450 enzyme
x abbreviation explanation d distance between the perpendicular dropped from the peak maximum and the leading edge of the peak at one-twentieth of the peak height D injected drug dose or volume of distribution DCM dichloromethane DOE design of experiments df film thickness in micrometer DPTMDS 1,3-diphenyl-1,1,3,3-tetramethyldisilazane EI electron ionization ER endoplasmic reticulum eV electron volt F bioavailability as the AUC comparison of AUC intra- and extravascular application FDA US Food and Drug Administration fa fraction of absorbed drug in the plasma fe unchanged renal extracted drug fraction ffp fraction of absorbed drug in the plasma after first-pass metabolism FFNSC flavors and fragrances of natural and synthetic compounds database FID flame ionization detector FTIR fourier transform infrared spectroscopy fu unbound drug fraction in plasma GC gas chromatography GF R glomerular filtration rate GIT gastrointestinal tract GST glutathion S-transferase H height equivalent to a theoretical plate or peak height for de- termination of S/N h noise of noise in a chromatogram HETP height equivalent to a theoretical plate HPLC high performance liquid chromatography I.D. inner diameter of a column IR infrared spectroscopy k10 drug elimination rate KM constant of Michaelis-Menten, describing the substrate con- centration at the half-maximal velocity of metabolic clearance KS association constant for chiral selector and (S)-enantiomer KR association constant for chiral selector and (R)-enantiomer LLE liquid-liquid extraction LOD limit of detection LogP partition coefficient LOQ limit of quantification LVI largen volume injection xi abbreviation explanation MeOH methanol MEPS microextraction by packed sorbent MPA methyl phenylacetate MPH methylphenidate MS or MSD mass spectrometry MSTFA N-methyl-N-trimethylsilyl-trifluoro-acetamide Mw molecular mass m/z mass-to-charge ratio N theoretical plate number of a chromatographic column NADPH nicotinamide adenine dinucleotide phosphate NDT N-desmethyl tramadol, pharmacologic inactive M2-meta- bolite of tramadol formed by CYP3A4 NMEs new molecular entities NP nitrophenol NPA nitrophenyl acetate ODT O-desmethyl tramadol, pharmacologic active M1-metabolite of tramadol formed by CYP2D6 P-buffer phosphate buffer PES polyethersulfone pI Isoelectric point pKa negative logarithm of the acid dissociation constant PBPK model physiologically based pharmacokinetic model Ph.Eur. Pharmacopoeia Europaea RA ritalinic acid RC regenerated cellulose RP column reversed phase column in liquid chromatography PTV programmed temperature vaporization injector Rs resolution of two adjacent peaks SE-52 5% phenyl-, 95% methylpolysiloxane matrix by BGB Ana- lytics SIM selected-ion monitoring S/N signal-to-noise ratio SPB-20 poly 20% phenyl, 80% dimethylsiloxane matrix by Supelco SPB-35 poly 35% diphenyl, 65% dimethylsiloxane matrix by Supleco SPE solid-phase extraction SPME solid-phase microextraction SSL split-splitless injector SULT sulfotransferase TBDMS tert - butyldimethylsilyl ether TIC total ion current TMD tramadol Torr unit of pressure (used in software of the MS detector) 1 Torr = 133.3224 Pa = 1.333 mbar
xii abbreviation explanation t1/2 half-life of a certain drug compound tR retention time of a peak UDP uridine diphosphate UDPGA uridine diphosphate glucuronic acid (UGT cofactor) UGT UDP-glucuronosyl transferase enzyme USP United States Pharmacopoeia UV-VIS ultraviolet-visible spectrophotometry V volume of distribution for a certain drug compound w0.05 width of a peak at one-twentieth peak height w0.5 width of a peak at half peak height
term explanation achiral molecule being superimposable with its mirror image simply by rotation in a plane acromegaly endocrinological disease with overexpression of growth hormone chiral nature of a molecule containing an asymmetric atom with four different substituents, mostly a carbon atom chiral center atom with four different substituents, commonly a car- bon atom Chiral separation reversible formation of diastereoisomers between enan- tiomers and a chiral selector with resulting separation of the enantiomers (KR 6= KS) chiral switch redevelopment of a marketed racemic drug to a single enantiomeric drug diastereoisomer stereoisomers with more than one chiral center and not being enantiomers of each other distomer pharmaceutically inactive or less active enantiomer enantiomer molecule existing in two different configurations, being mirror images, with at least one chiral center and sha- ring same physico-chemical properties in a non-chiral environment eutomer pharmaceutically active enantiomer first-pass metabolism after oral administration, metabolism of absorbed drug prior to reaching systemic circulation
xiii term explanation isomers molecules with same molecular mass because of equal atom number qualitatively and quantitatively, dif- fering in constitution and in physico-chemical pro- perties metabolism transformation of endo- and exogenous substances in a biological system into physiologically active or in- active compounds that are often more hydrophilic narcolepsy disease with imperative urge to sleep during the day optical activity ability of a molecule to rotate polarized light in a plane by compound specific amounts pharmacodynamics description of drug response and pharmacological ef- fects in a body pharmacokinetics description of concentration changes, metabolite for- mation and drug transport within a body prodrug inactive drug compound with optimized pharmaco- kinetic properties (enhanced absorption), that is en- zymatically metabolized after systemic availability to its active metabolite racemate mixture of enantiomers in equimolar amounts and with absence of optical activity stereoisomers molecules with same molecular formula, but with dif- ferent three-dimensional arrangement. Enantiomers and diastereoisomers are stereoisomers stereoselectivity specific preference for one stereoisomer over another xenobiotic artificial compound found in the body like drugs, pol- lutants, flavors, preservative agents and others with- out physiological function
xiv Chapter 1
Introduction
1.1 Chirality - Same Things, but Different
The physicist Sir William Thomson (Lord Kelvin) was probably not aware in 1883 that he would give name to an essential dimension in nature and sciences. Chira- lity, as he called it, describes the state of geometrically identical figures not to be superimposable by any rotation, only by being mirror images [1]. The meaning of chirality comes from the Greek root ”χιρ” (”cheir”), which means handed. Hands show mirror images of each other. Chirality is omnipresent and important in biological systems, mainly observed as carbon-atoms bonded to four different substituents. A molecule having one chiral center has one mirror image called enantiomer or optical isomer. Enantiomers have same properties, but are able to polarize light in the opposite direction (optical activity). They may exert different properties in an asymmetric environment. Dia- stereoisomers are isomers, having two or more chiral centers (C-, P-, S-atom with four different substituents). They differ in physicochemical properties. Today, chiral conformation of a compound is denoted with (S)- or (R)-descriptors by the Cahn- Ingold-Prelog priority rules [2]. For sugars and amino acids, the Fisher-convention (d-, l-forms) is still popular and also the optical rotation with (+)- or (-)-notation (not related to Cahn-Ingold-Prelog priority rules) is often used [3]. In nature commonly one enantiomeric form is formed or preferred in synthesis and biological function, for example l-amino acids or d-sugars (glucose, fructose, cel- lulose). Biological receptors recognize and discriminate in most cases chiral isomers. For example volatile enantiomers may smell differently. An exemplary compound, but rare with that clear distinction, is carvone (figure 1.1). The monoterpene (S)- carvone has a typically caraway flavor, whereas (R)-carvone smells like spearmint [4]. Racemates consist of equimolar enantiomer amounts and have no optical activity. Many drugs on the market are chiral. The rising awareness of differing enan- tiomeric properties in asymmetrical environment has led chirality to become a major theme in design, discovery, development, patenting and marketing of new drugs since the early 1980s [5,6]. Drug chirality is distinguished in achiral, racemate and single
1 Chapter 1. Introduction
Figure 1.1: Carvone enantiomers are stereoselectively recognized by olfactory receptors. (S)-carvone smells like caraway, where (R)-carvone has a spearmint odor.
enantiomer. Since racemic drugs are considered as two different drugs administered at the same time, a chiral switch to single enantiomeric drugs has gained importance and has also been supported by the US Food and Drug Administration (FDA). In the development of new molecular entities (NMEs) single enantiomers are preferred nowadays. As it is known that in many cases the preferred therapeutic effect re- sides in one enantiomer only. Therefore, it was predicted that the development and approval for racemates will vanish rapidly and only single enantiomers be of further interest. Annual publication of the distribution of worldwide-approved drugs shows instead a still persisting constant number of marketed NMEs in racemic form [5,7]. Not only commercial or marketing strategies are the rationale for rejecting the chiral-switch strategy. Certain enantiomer pairs show synergistic or antagonistic properties or even inversion towards the other form occurs. One example is the weak opioid agonist tramadol, which is approved in racemic form only. Tramadol enantiomers demonstrate increased adverse effects after enantiomeric administra- tion and analgesia is significantly reduced in comparison to racemic drug adminis- tration [8]. A second example is methylphenidate. This compound is used for the treatment of attention deficit hyperactivity disorder in children and adults. Chiral switch strategy has led to the occurrence of racemic and enantiopure formulations on the market [9]. A third drug is ibuprofen, a non-steroidal analgesic, also marketed in racemic and single enantiomeric form. Although the analgesic activity resides just in the eutomer (S)-ibuprofen, the racemic drug is still preferred because in vivo the distomer, inactive drug enantiomer ((R)-ibuprofen) is slowly converted to the eutomer (S)-ibuprofen [10–15]. This inversion is particularly considered in the formulation of long acting drugs, where the presence of the racemate is preferred. In contrast, for rapid analgesic onset the intake of the single enantiomer is chosen, but because of short half-life, the analgesic effect is of short duration. With this background, extra regard is needed for drug intake during pregnancy, where new pharmacokinetic and pharmacodynamics conditions appear and chiral (particularly racemic) drugs may elicit unexpected responses. The following section gives an insight to changes and risks of drug administration during pregnancy.
2 1.2. Pregnancy
1.2 Pregnancy
A woman undergoes in pregnancy profound changes that affect the anatomy of a woman by obvious alterations (total body weight gain, pelvis dilatation etc.). Also the physiology is involved with dynamic changes. Comparing those physiological changes with the physiology of non-pregnant women, quite unhealthy conditions have to be suggested. However, the body of pregnant women generally nicely toler- ates those drastic changes, but in case of drug treatment, dose adjustments have to be considered, as the following part explains. To ensure an optimal development of the fetus, many physiological parameters are changed reversibly during pregnancy. Most changes initiate at early pregnancy. In table 1.1 relevant parameters are reported. The interpolated values are calculated from functions based on measured data from Abduljalil et. al. [16].
Table 1.1: Calculated relative changes of anatomical and physiological parameters during pregnancy on the basis of published reference data [16]. anatomical, physiological relative changes in pregnancy com- and biological parameters pared to non-pregnant average volume (%) non- unit end of first end of second end of third pregnant trimester trimester trimester average (week 13) (week 27) (week 40-42) value total body weight 61.1 kg 6.2 15.2 27.5 total fat mass 17.14 kg 10.7 24.0 40.2 total body water 31.67 L 12.6 29.0 49.8 cardiac output 301 L/h 20.6 31.8 31.0 plasma volume 2.5 L 10.6 43.3 51.4 red blood cell volume 1.49 L 8.6 17.8 27.6 plasma protein concentration 69.7 g/L -1.6 -6.9 -0.8 total lipid concentration 6.0 g/L 21.7 45.0 70.1 CYP1A2 activity 100 activity -38.2 -60.6 -63.1 CYP2D6 activity 100 activity 23.6 35.9 33.9 CYP3A4 activity 100 activity 26.3 26.5 0.7 glomerular filtration rate 114 mL/min 28.4 40.1 30.7 effective renal blood flow 53.1 L/h 44.1 44.6 1.3 estradiol concentration 0.062 ng/mL 3977 14540 33085 progesterone concentration 1.42 ng/mL 2278 6079 15408
The cardiovascular system has an increased cardiovascular output (CO) as a re- sult of increased heart rate and stroke volume. In contrast, systemic and pulmonary vascular resistances decrease. The resulting physiologic hypotension is present at weeks 14 - 24. While maternal blood volume increases, a hemodilutional anemia and decrease in serum colloid osmotic pressure occurs with maximal values at weeks 30 - 32. As albumin and erythrocyte concentration drop, protein binding is reduced. The decrease of erythrocyte concentration and risk of deficient oxygen transport is counterbalanced by erythrocyte size growth. Leucocyte production is increased and coagulation as well, since fibrinolysis is altered leading to a hypercoagulable state.
3 Chapter 1. Introduction
This explains the higher risk for pregnancy-induced thromboembolism [16–18]. Also the respiratory system undergoes mechanical and functional changes. The sudden and enormous increase in estradiol concentration leads to hypervascularity in the respiratory system. The tidal volume increases, but the respiratory rate and vital capacity remain unchanged. This is still the case even though the increasing intra-abdominal pressure moves the diaphragm upward by up to 4 - 5 cm and the alveoli at the bases of the lungs collapse [18–20]. The renal system shows at the end of the first trimester a significant elevation in the glomerular filtration rate (GF R) of approximately 30 - 50%. Creatinine and blood urea concentrations decrease consequently. Natriuresis is favored by the ele- vated progesterone concentration, but elevated levels of aldosterone compensate the loss of sodium. This leads to a net sodium and water retention and therefore to the increase in total body water. Until end of pregnancy about 6 liters extracellular and 2 liters intracellular water are accumulated. In parallel, renal clearance augments until the third trimester to about doubled value compared to pre-pregnant state and normalizes until delivery [17, 18, 21]. In pregnancy, the gastrointestinal system has prolonged gastric emptying and intestine transit. The motility of the gall bladder is reduced, leading to a delayed absorption and to a certain risk for cholelithiasis. Also the endocrine system is affected by presenting a diabetogenic state, where increased insulin resistance is observed. Other hormones as well, not discussed in more detail, show a different secretion pattern in pregnancy [18, 19]. Metabolic changes occur as a result of altered enzyme expression in the liver or extra hepatic. These proteins generally transform xenobiotics into inactive com- pounds. Also transformation of xenobiotics to toxic metabolites or active metabo- lites may occur [22]. There are studies implying cases where fetal metabolism in animals led to higher metabolite concentrations in the fetus compared to the mother [23]. As described earlier, during pregnancy all pharmacokinetic events like absorp- tion, distribution, metabolism and excretion (ADME) are concerned. These changes have a significant impact on pharmacokinetics and pharmacodynamics. This implies the need for drug dose considerations and adaptions for compounds used in preg- nancy. In particular drugs, mainly unchanged renally eliminated, require a dosage adjustment to maintain pre-pregnant plasma concentrations. Most drugs employed during pregnancy are not developed or tested for use in gestation [24–26]. To assure maternal and fetal safety, information about appropri- ate treatment, dosing (amount, interval) and efficacy must be provided. But still, particularly old drugs are used for treatment in pregnancy. These compounds are often applied without official approval for pregnant women. This ”off-label use” generates only little data or case reports and it is the reason, why preferably old compounds are employed. The development of new drugs generally does not include studies with pregnant women, unless it is indicated for that purpose. This is due to ethical concerns or difficult study designs.
4 1.3. Pharmacokinetics and Pharmacodynamics
However, with growing insight and knowledge of diseases a new focus in clinical treatment of pregnant women has been developed. Nowadays women under medical long-term treatment are able to get pregnant even if the medical treatment needs to be continued. It is known that more than 90% of pregnant women need medical long-term treatment or a short-term medication [27–30]. The wellbeing of a mother is important, since health of the mother also influences the development of the fetus. Consequently, an appropriate balancing of benefit and risk is needed. In many cases the risk of health threatening conditions for the mother by withdrawing a treatment is higher estimated than possible harming of the fetus by continuation of a treatment. Efforts are undertaken to identify harmful drug compounds and their risk covering multiple- (e.g. isotretinoin, statins, ACE inhibitors) or single-use of drugs (e.g. thalidomide). The understanding of drug risk in pregnancy requires knowledge about the phys- iology of pregnant women [17, 21, 31]. Not only physical malformations, but also neuro-developmental disorders representing long-time effects can happen. The first trimester is the most vulnerable period for physical malformations. In the second and third trimester neuronal differentiation and organ maturation takes place with an increased risk for neuro-developmental retardation [32–34]. The following section will focus on the physiological changes during pregnancy.
1.3 Pharmacokinetics and Pharmacodynamics
Pharmacokinetics describes kinetic processes of a drug in the body. These processes are divided into four parts, called ADME, where absorption (A) reflects the uptake of a drug compound through the gastrointestinal tract (GIT) or the skin. Distribution (D) designates the dispersion of the drug in the body. Metabolism (M) and excretion (E) specify the elimination of the drug from the body by modifying the parent compound to metabolites or by withdrawing the parent drug through the kidneys or other organs [35]. Pharmacodynamics is of particular interest with new molecular entities (NMEs) and unknown compounds. It describes the effects of a molecule or a metabolite in the body. Generally, pharmacokinetic core-parameters (t1/2, V , fe, fu, F ) with constant values under standard conditions are used to calculate plasma concentrations. In case of co-medications for an individual person, the parameters allow to calculate dose corrections. These core-parameters are also important to predict drug response in the body as a pharmacokinetic profile. The parameters of approved drug com- pounds are listed in literature [36]. In pregnancy, pharmacokinetic core-parameters change and literature core-para- meters are imprecise. This explains the risk for changed drug response or changed metabolite formation. Figure 1.2 illustrates the kinetic in vivo processes, which in most cases can be
5 Chapter 1. Introduction
Aa(t)
ka
A(t) A(t)
C(t) C(t)
k10 k10
Ael(t) Ael(t)