Extremely low dose of 6-mercaptopurine in a Chinese child with acute lymphoblastic leukaemia and multiple pharmacogenetic mutations.

WHAT IS KNOWN AND OBJECTIVES: Thiopurines are cornerstone drugs in the treatment of acute lymphoblastic leukaemia (ALL), but their use can be complicated by the incidence of life-threatening leucopenia. CASE DESCRIPTION: We describe a case of a 6-year-old Chinese boy with B-ALL receiving extremely low dose of 6-mercaptopurine (only 4% of recommended dose) during the ALL maintenance therapy phase. WHAT IS NEW AND CONCLUSION: Complex pharmacogenetic tests and TDM should be recommended in children with complicated ALL to highlight the large individual variability in the responses to 6-MP exposure and the associated adverse effects.

Platinum nanozyme-encapsulated poly(amidoamine) dendrimer for voltammetric immunoassay of pro-gastrin-releasing peptide.

An innovative electrochemical immunosensing platform was designed for the sensitive monitoring of lung cancer biomarker (pro-gastrin-releasing peptide; ProGRP) by using platinum nanoparticles encapsulated inside dendrimers (PtDEN) as enzymatic mimics for the signal amplification. PtDEN nanocomposites were prepared through a simple chemical reduction method with the assistance of NaBH4. Thereafter, PtDEN-labeled anti-ProGRP secondary antibody was launched for the detection of target analyte with a sandwich-type assay format on anti-ProGRP capture antibody-modified screen-printed carbon electrode. Accompanying formation of immunocomplex, the labeled PtDENs electrochemically oxidized 3,3',5,5'-tetramethylbenzidine (TMB) in the presence of hydrogen peroxide to produce a well-defined voltammetric signal within the applied potentials. Thanks to the high-efficient catalytic efficiency of platinum nanoparticles and high-loading ability of dendrimer, improved analytical features were acquired with PtDENs relative to platinum nanoparticles alone. Using PtDENs labeling strategy, the properties and factors influencing the analytical performance of electrochemical immunosensor were studied in detail. The strong bioconjugation of antibodies with the PtDENs caused a good repeatability and intermediate precision down to 7.64%. Under optimum conditions, the electrochemical immunosensor exhibited a dynamic linear range of 0.001-10 ng mL-1 ProGRP with a detection limit of 0.86 pg mL-1. Good selectivity and relatively long-term stability (>6 months) were achieved for target ProGRP. Significantly, the acceptable accuracy was gotten for analysis of ProGRP in human serum specimens referring to commercially available human ProGRP enzyme-linked immunosorbent assay (ELISA) method.

Cross-linkage urease nanoparticles: a high-efficiency signal-generation tag for portable pH meter-based electrochemical immunoassay of lipocalin-2 protein diagnostics.

An innovative signal-transduction tag based on cross-linked urease nanoparticles (CLENP) was designed for the development of a pH meter-based immunoassay of lipocalin-2 (LCN2). The CLENP was synthesized with a typical desolvation method using ethanol as desolvation agent, followed by functionalization with polyaspartic acid. The carboxylated CLENP were used as the signal-generation tags for the labelling of secondary antibodies via the carbodiimide coupling. Upon target LCN2 introduction, a sandwich-type immune reaction was performed between capture antibody-coated plate and the labeled secondary antibody on the CLENP. The conjugated CLENP in the microplate hydrolyzed urea into ammonia (NH4+) and carbonate (CO32-), resulting in the pH change of solution, which was determined with a handheld pH meter. The pH variation was proportional to target concentration in the sample. By monitoring the pH variation of the urea solution, the level of LCN2 at a concentration as low as 5.2 pg mL-1 was evaluated. The pH meter-based electrochemical immunoassay can be utilized for mass production of miniaturized lab-on-a-chip devices with handheld pH meter, thereby opening new opportunities for protein diagnostics and biosecurity. Graphical abstract An innovative signal-transduction tag based on cross-linked urease nanoparticles was designed for high-efficiency immunoassay of lipocalin-2 with pH meter readout.

In situ amplified photothermal immunoassay for neuron-specific enolase with enhanced sensitivity using Prussian blue nanoparticle-loaded liposomes.

Methods based on prussian blue nanoparticles (PBNPs) have been reported for photothermal immunoassays in analytical nanoscience fields but most suffer from low sensitivity and are not beneficial for routine use. Herein, we design an in situ amplified near-infrared (NIR) photothermal immunoassay for the quantitative screening of neuron-specific enolase (NSE) on a portable thermometer using PBNP-encapsulated nanoliposomes as photosensitive materials. Biotinylated liposomes loaded with numerous prussian blue nanoparticles were synthesized through a typical reverse-phase evaporation method. The photothermal immunoassay was carried out in an anti-NSE capture antibody-coated microplate using the biotinylated anti-NSE secondary antibody. With the sandwiched immunoreaction and the biotin-avidin linkage, the subsequent photothermal measurement of PBNPs released from the liposomes with buffered surfactant including Tween 20 was conducted on a digital thermometer under near-infrared 808 nm laser irradiation, accompanied by the convertion of NIR-light wavelength to heat. Under the optimum conditions, the photothermal immunoassay displayed a wide dynamic concentration range of 0.1-100 ng mL-1 with a low detection limit for NSE of 0.053 ng mL-1. Good reproducibility (RSD ≤ 2.78% for intra-assay; RSD ≤ 4.39% for inter-assay), high selectivity against other biomarkers, and a long-term stability (≥94.9% of the initial signal during six-month storage) were acquired in the photothermal immunoassay. Impressively, the analysis of 7 human serum specimens for target NES via the photothermal immunoassay also gave well-matched results with the referenced human NSE enzyme-linked immunosorbent assay.

Precision therapy of 6-mercaptopurine in Chinese children with acute lymphoblastic leukaemia.

AIMS: Chinese children are more susceptible to the development of thiopurine-induced leukopenia compared with Caucasian populations. The aim of our study was to establish a 6-mercaptopurine (6-MP) dose-concentration-response relationship through exploration of pharmacogenetic factors involved in the thiopurine-induced toxicities in Chinese paediatric patients afflicted by acute lymphoblastic leukaemia (ALL). METHODS: Blood samples were obtained from ALL children treated with 6-MP. We determined the metabolite steady-state concentrations of 6-MP in red blood cells (RBCs) by using high-performance liquid chromatography. Pharmacogenetic analysis was carried out on patients' genomic DNA using the MassArray genotyping platform. RESULTS: Sixty children afflicted by ALL who received 6-MP treatment were enrolled in this study. The median concentration of 6-thioguanine in patients afflicted by leukopenia was 235.83 pmol/8 × 108 RBCs, which was significantly higher than for patients unafflicted by leukopenia (178.90 pmol/8 × 108 RBCs; P = 0.029). We determined the population special target 6-thioguanine threshold to have equalled 197.50 pmol/8 × 108 RBCs to predict leukopenia risk in Chinese paediatric patients afflicted by ALL. Among 36 candidate single nucleotide polymorphisms, our results indicated that NUDT15 (rs116855232) and IMPDH1 (rs2278293) were correlated with a 5.50-fold and 5.80-fold higher risk of leukopenia, respectively. MTHFR rs1801133 variants were found to have had a 4.46-fold significantly higher risk of hepatotoxicity vs wild-type genotype. CONCLUSION: Our findings support the idea that predetermination of genotypes and monitoring of thiopurine metabolism for Chinese paediatric patients afflicted by ALL is necessary to effectively predict the efficacy of treatments and to minimize the adverse effects of 6-MP maintenance therapy.

Population Pharmacokinetics and Dosing Optimization of Imipenem in Children with Hematological Malignancies.

Imipenem is widely used for the treatment of children with serious infections. Currently, studies on the pharmacokinetics of imipenem in children with hematological malignancies are lacking. Given the significant impact of disease on pharmacokinetics and increased resistance, we aimed to conduct a population pharmacokinetic study of imipenem and optimize the dosage regimens for this vulnerable population. After children were treated with imipenem-cilastatin (IMP-CS), blood samples were collected from the children and the concentrations of imipenem were quantified using high-performance liquid chromatography with UV detection. Then, a population-level pharmacokinetic analysis was conducted using NONMEM software. Data were collected from 56 children (age range, 2.03 to 11.82 years) with hematological malignancies to conduct a population pharmacokinetic analysis. In this study, a two-compartment model that followed first-order elimination was found to be the most suitable. The parameters of current weight, age, and creatinine elimination rate were significant covariates that influenced imipenem pharmacokinetics. As a result, 41.4%, 56.1%, and 67.1% of the children reached the pharmacodynamic target (the percentage of the time during the total dosing interval that the free drug concentration remains above the MIC of 70%) against sensitive pathogens with an MIC of 0.5 mg/liter with imipenem at 15, 20, and 25 mg/kg of body weight every 6 h (q6h), respectively. However, only 11.1% of the children achieved the pharmacodynamic target against Pseudomonas aeruginosa isolates with an MIC of 2 mg/liter at a dose of 25 mg/kg q6h. The population pharmacokinetics of imipenem were assessed in children. The current dosage regimens of imipenem result in underdosing against resistant pathogens, including Pseudomonas aeruginosa and Acinetobacter baumannii However, for sensitive pathogens, imipenem has an acceptable pharmacodynamic target rate at a dosage of 25 mg/kg q6h. (The study discussed in this paper has been registered at ClinicalTrials.gov under identifier NCT03113344.).

Population pharmacokinetics and dosing optimization of cefathiamidine in children with hematologic infection.

PURPOSE: Cefathiamidine, a first-generation cephalosporin, has approval from the China Food and Drug Administration for the treatment of infections caused by susceptible bacteria in both adults and children. As pharmacokinetic data are limited in the pediatric population, we aimed to evaluate the population pharmacokinetics of cefathiamidine in children and to define the appropriate dose in order to optimize cefathiamidine treatment. METHODS: Blood samples were collected from children treated with cefathiamidine, and concentrations were quantified by high-performance liquid chromatography and tandem mass spectrometry. Population pharmacokinetic analysis was conducted using NONMEM software. RESULTS: Fifty-four children (age range: 2.0-11.8 years) were included. Sparse pharmacokinetic samples (n=120) were available for analysis. A two-compartment model with first-order elimination showed the best fit with the data. A covariate analysis identified that bodyweight had a significant impact on cefathiamidine pharmacokinetics. Monte Carlo simulation demonstrated that the currently used dosing regimen of 100 mg/kg/day q12h was associated with a high risk of underdosing in pediatric patients. To reach the target 70% fT>MIC, a dose of 100 mg/kg/day cefathiamidine q6h is required for effective treatment against Haemophilus influenzae. CONCLUSION: A population pharmacokinetics model of cefathiamidine in children with hematologic disease was established. A dosing regimen of 100 mg/kg/day cefathiamidine q6h should be used in clinical practice against H. influenza infections.