Metodología para elaborar el Plan Maestro de Validación de los procesos de producción del Centro Nacional de Sanidad Agropecuaria / Methodology to design the Master Plan of Validation of production processes of National Center of Agricultural Health

La metodología para la elaboración del Plan Maestro de Validación de los procesos de producción del Centro Nacional de Sanidad Agropecuaria, se diseñó a partir de los requisitos contenidos en la Regulación 16 del 2006 de Buenas Pràcticas de Fabricación de medicamentos. Abarcó la política de la organización para la actividad de validación su estructura organizativa, las instalaciones, sistemas, equipos y procesos que se deben validar; el formato de la documentación a utilizar; la planificación y calendario de cada actividad; los resultados de cada protocolo ejecutado, el control de los cambios que se generan; un resumen de las validaciones anteriores; cumplimiento del plan propuesto; las conclusiones donde se precisan de forma resumida si los procesos validados estàn bajo control, los resultados màs relevantes, así como las acciones correctivas y preventivas a tomar; por último se define la distribución de toda la información generada, conformando así el Plan Maestro de Validación. Este sistema de validación se muestra a través de procedimientos, protocolos y registros aplicados en el proceso de fabricación de Surfacen®, medicamento para uso humano que se fabrica en el Centro Nacional de Sanidad Agropecuaria.

The methodology to design the Validation Master Plan the production processes of National Center of Agricultural Health was created from the requirements present in the Regulation 16, 2006 of Good Practices of drugs manufacture including the organization policy for validation activity of its organizing structure, installations, systems, equipments and processes to be validated, documentation format used, planning and calendar of each activity; the results from each protocol performed, the generating changes control, abstract of prior validations, fulfillment of proposed plan, conclusions where are determined in a summarized way if the validated processes are under control, the more relevant results, as well as how the corrective and preventive actions executed, and lastly, the distribution of all the generated information is defined, thus creating the validation of Master Plan. This validation system is showed thorough procedures, protocols and registries applied in manufacturing process of Surfacen® a human use drug manufactured in the National Center of Agricultural Health.

Metodología para elaborar el Plan Maestro de Validación de los procesos de producción del Centro Nacional de Sanidad Agropecuaria / Methodology to design the Master Plan of Validation of production processes of National Center of Agricultural Health

La metodología para la elaboración del Plan Maestro de Validación de los procesos de producción del Centro Nacional de Sanidad Agropecuaria, se diseñó a partir de los requisitos contenidos en la Regulación 16 del 2006 de Buenas Pràcticas de Fabricación de medicamentos. Abarcó la política de la organización para la actividad de validación su estructura organizativa, las instalaciones, sistemas, equipos y procesos que se deben validar; el formato de la documentación a utilizar; la planificación y calendario de cada actividad; los resultados de cada protocolo ejecutado, el control de los cambios que se generan; un resumen de las validaciones anteriores; cumplimiento del plan propuesto; las conclusiones donde se precisan de forma resumida si los procesos validados estàn bajo control, los resultados màs relevantes, así como las acciones correctivas y preventivas a tomar; por último se define la distribución de toda la información generada, conformando así el Plan Maestro de Validación. Este sistema de validación se muestra a través de procedimientos, protocolos y registros aplicados en el proceso de fabricación de Surfacen®, medicamento para uso humano que se fabrica en el Centro Nacional de Sanidad Agropecuaria(AU)

The methodology to design the Validation Master Plan the production processes of National Center of Agricultural Health was created from the requirements present in the Regulation 16, 2006 of Good Practices of drugs manufacture including the organization policy for validation activity of its organizing structure, installations, systems, equipments and processes to be validated, documentation format used, planning and calendar of each activity; the results from each protocol performed, the generating changes control, abstract of prior validations, fulfillment of proposed plan, conclusions where are determined in a summarized way if the validated processes are under control, the more relevant results, as well as how the corrective and preventive actions executed, and lastly, the distribution of all the generated information is defined, thus creating the validation of Master Plan. This validation system is showed thorough procedures, protocols and registries applied in manufacturing process of Surfacen® a human use drug manufactured in the National Center of Agricultural Health(AU)

Quality control validation for exogenous natural surfactant labeled with 99mTc.

OBJECTIVE: Exogenous natural surfactant (ENS) labeled with 99mTc shows an elevated lung specificity allowing the acquisition of high-quality images for ventilation scintigraphy. METHODS: The methods for 99mTc-ENS quality control (physical properties, pH determination, radiochemical studies, and biologic studies) were evaluated and validated. RESULTS: The physical properties of the nonradioactive precursor and of the radiopharmaceutical were analyzed as general descriptors of the product. The pH of the radiopharmaceutical was determined by using pH test papers, a method described and validated in the United States Pharmacopeia. Chromatographic studies performed using the acetone/Whatman-1 paper system were validated as a method to evaluate the radiochemical purity of the 99mTc-ENS. Biodistribution studies on rats after intratracheal administration were validated as a method to estimate the radiopharmaceutical biodistribution in humans. CONCLUSION: The proposed method for 99mTc-ENS quality control studies and stability studies was evaluated and validated following international standards.

Exogenous surfactant therapy: newer developments.

There are numerous pulmonary conditions in which qualitative or quantitative anomalies of the surfactant system have been demonstrated. In premature newborns with immature lungs, a functional deficit in surfactant is the main physiopathologic mechanism of the neonatal respiratory distress syndrome (RDS). Since the landmark pilot study of Fujiwara, published more than 20 years ago, the efficacy of exogenous surfactant for the treatment of neonatal RDS has been established by numerous controlled studies and meta-analyses. Promising results have also been reported in infants suffering from other lung disorders in which endogenous surfactant function is compromised. Enlightened by a growing insight into both the structure and function of the different surfactant components, a new generation of synthetic surfactants has been developed. Various complementary approaches have confirmed the fundamental role of the two hydrophobic proteins, SP-B and SP-C, in the surfactant system, thus opening the way to the design of analogues, either by chemical synthesis or expression in a prokaryotic system. These peptide-containing synthetic surfactant preparations are presently undergoing clinical trials, and may eventually replace the animal-derived surfactants currently used for the treatment of RDS.

99mTc-ENS: a new radiopharmaceutical for aerosol lung scintigraphy. Comparison between different freeze-dried formulations.

UNLABELLED: Exogenous natural surfactant (ENS) labeled with 99mTc(99mTc-ENS) is a new radiopharmaceutical for pulmonary aerosol scintigraphy. In this study, different freeze-dried formulations were evaluated to develop a suitable and long-storage method for the ENS, the nonradioactive precursor of this radiopharmaceutical. METHODS: Two freeze-dried formulations were evaluated: the sterile ENS suspension-stannous chloride altogether lyophilized (chlorlioENS) and the lyophilized sterile ENS suspension with the addition of stannous chloride as a solid drug (lioENS). These precursors were stored at room temperature for 3 mo and then labeled with 99mTc. For comparative purposes, the sterile ENS suspension with the addition of stannous chloride labeled with 99mTc(99mTc-chlorENS) was also studied. The quality controls for each radiopharmaceutical were performed by an ascending paper chromatography to determine the labeling yield percentages. The study was performed in 30 female Sprague Dawley rats, which inhaled each radiopharmaceutical by nebulization. Twenty-five minutes after the aerosol inhalation, the animals were killed to extract their organs and measure their activity in a gamma spectrometer. The data are given as the percentage of activity concentration (C%) for each organ. RESULTS: The physicochemical properties of lioENS were adequate for a freeze-dried product. The labeling yields for 99mTc-lioENS and for 99mTc-chlorENS were always greater than 95% even after nebulization. The results of the biologic distribution studies showed that the activity concentration found in lungs for these radiopharmaceuticals were 95.7% +/- 2.6% and 96.7% +/- 2.6% respectively, results that do not differ statistically. On the other hand, the activity concentration found in lungs for the 99mTc-chlorlioENS (31.3% +/- 11.1%) and its labeling yield percentages (<10%) are statistically different (P < 0.05) from the results obtained with the two radiopharmaceuticals mentioned above. CONCLUSION: Taking into account the lioENS physicochemical properties, its long shelf life and that 99mTc-lioENS shows the same radiochemical and radiopharmacological behavior of the 99mTc-chlorENS, it can be concluded that the 99mTc-lioENS can be used for aerosol lung scintigraphy.

An in-house ELISA method for measuring surfactant protein A.

An in-house enzyme-linked immunoabsorbant assay (ELISA) for SP-A was successfully developed using in-house polyclonal anti SP-A and a commercial polyclonal anti-rabbit immunoglobulin horseradish peroxidase conjugate system. The standard curve, generated by using 50 ng of SP-A to coat the plate and 1:500 dilution of polyclonal anti SP-A as a primary antibody, was linear for concentrations of SP-A ranging from 4 micrograms/l to 4000 micrograms/l and reproducible. Results of recovery study of SP-A from a known sample of tracheal aspirate ranged from 94%-114%. Intra- and inter-assay coefficients of variations were 2.7% and 5.6% respectively for a known sample of tracheal aspirate. Interference study showed that tracheal aspirate did not interfere with the assay. The assay developed was intended to be used for SP-A measurement in tracheal aspirates obtained from neonates with and without respiratory distress syndrome.

Overview of clinical trials comparing natural and synthetic surfactants.

This overview summarizes the ten randomized clinical trials that have compared different surfactant preparations. Six trials, enrolling 2,450 babies with respiratory distress syndrome (RDS), compared Survanta and Exosurf. Babies treated with the natural surfactant had lower oxygen requirements for at least 3 days than those treated with the synthetic surfactant. The babies treated with Survanta had lower risks of neonatal mortality (odds ratio, OR, 0.80; 95% confidence interval, CI, 0.65-1.00), retinopathy of prematurity (OR 0.68; 95% CI 0.50-0.94), and death or bronchopulmonary dysplasia (OR 0.84; 95% CI 0.70-1.00) when compared to those treated with Exosurf. Infasurf has been compared with Exosurf in two studies: one as prophylaxis and the other a rescue trial. Similar, although non-significant benefits were found for the natural surfactant. When all eight trials were included in a meta-analysis, there was a significant reduction in the odds of pulmonary air leaks (OR 0.52; 95% CI 0.41-0.66) for babies treated with natural as compared with synthetic surfactants. For seven trials (3,576 babies) comparing natural and synthetic surfactants to treat RDS (six comparing Survanta and Exosurf and one Infasurf and Exosurf), there was a significantly reduced risk of neonatal mortality (OR 0.80; 95% CI 0.66-0.97) with natural as compared with synthetic surfactant treatment. In two further trials different natural surfactant preparations have been compared. Reduced oxygen needs for 24 h after treatment were found for Infasurf and Curosurf, respectively, when compared to Survanta. Apparent longer-term benefits from these surfactants were not statistically significant. Further trials are needed to be certain of the differences between various surfactant preparations.

Factors influencing efficacy of exogenous surfactant in acute lung injury.

Exogenous surfactant is currently being tested as a therapeutic modality for patients with acute respiratory distress syndrome (ARDS). Animal studies have shown that several factors may influence the efficacy of this treatment modality. These factors include the surfactant delivery method used (instillation vs. aerosolization), the timing of surfactant treatment over the course of injury, the specific surfactant preparation used, and the dose of surfactant administered. Each of these factors alone and together may influence the interaction of the exogenous surfactant with the host's alveolar environment. This, in turn, may dictate how a specific patient responds to a particular surfactant treatment strategy. It is suggested that patients at an early stage of lung injury will benefit from aerosolized exogenous surfactant whereas large quantities of an instilled exogenous surfactant may be necessary at later stages of injury. Future studies will clarify how a specific surfactant treatment strategy should be chosen for an individual patient with ARDS.

Neonatal and infant care and outcomes.

A major advance in neonatal care, surfactant replacement therapy, has received wide endorsement and approval after being subject to over 30 clinical trials. Details of clinical application and full impact on outcomes are in the process of being determined. Neonatal outcome data indicate that the focus of improvement in survival now rests primarily on the extremely low birth weight (less than 750 g) infant. There is additional need for clarity of actual survival by gestational age in the less-than-28-week cohort. The differences and limitations of neonatal and obstetric methods of gestational age assessment are important. Significant contributions to our knowledge of problems such as retinopathy of prematurity, syphilis, and infants of diabetic mothers have recently appeared.