High-performance liquid chromatographic method for the determination of mycophenolate mofetil in human plasma

A method for the quantification of mycophenolate mofetil (MMF, CellCept) in plasma using solid-phase extraction and HPLC is described here. A solution of internal standard is added to a 0.5-ml plasma aliquot. The resulting sample is treated with water and dilute HCl and applied to a C₁₈ solid-phase extraction column. After a water wash, the MMF and internal standard are eluted with methanol-0.1 M citrate-phosphate buffer, pH 2.6 (80:20, v/v). A 20-μl aliquot of the eluate is injected onto a C₁₈ column (5 μm particle size, 150 × 4.6 mm I.D.) and eluted at ambient temperature with acetonitrile-0.05 M citrate-phosphate buffer, pH 3.6, containing 0.02 M heptanesulfonic acid (41:59, v/v). Quantification is achieved by UV detection at 254 nm. The method is reproducible, accurate and specific for MMF. Using 0.5 ml of plasma for analysis, the quantification limit is 0.400 μg/ml and the range is 0.400–20 μg/ml. Based on the stability profile of MMF in plasma, it is recommended that blood samples collected following intravenous infusion be immediately stored on ice and that plasma be prepared rapidly, immediately stored frozen at −80°C and analyzed within four months of collection.     

MMF联合泼尼松治疗成人特发性膜性肾病的疗效及安全性研究

目的:探究吗替麦考酚酯(MMF)联合泼尼松(Pre)治疗成人特发性膜性肾病(IMN)的疗效及安全性。方法:选取2015.06-2017.06我院收治的102例行IMN患者列为研究对象,将患者按随机数字表法以1:1比例分为对照组与观察组,每组各51例,对照组患者使用Pre进行治疗,观察组患者使用MMF+Pre进行治疗,治疗12个月。比较两组治疗12个月后疗效,治疗前、治疗后6个月及12个月后肾功能相关指标[24 h尿蛋白定量(24 h UP)、血清胱抑素C(CysC)、血清尿素氮(BUN)、血清肌酐(Scr)、血清白蛋白(Alb)]、脂代谢指标[总胆固醇(TC)、甘油三酯(TG)],并记录用药间期出现的药物不良反应。结果:治疗12个月后,研究组患者总有效率为90.20%,显著高对照组74.51%(P0.05);治疗6个月、12个月后,两组患者24 h UP、Cys C、TC、TG水平较治疗前均依次显著下降而Alb水平显著上升(P0.05),且观察组上述指标与同期对照组对比差异显著(P0.05);而两组BUN和Scr水平较治疗前差异不显著(P0.05),两组对比无统计学意义(P0.05)。治疗期间,观察组患者药物不良反应率为11.76%,显著低于对照组27.45%(P0.05)。结论:应用MMF联合泼尼松治疗成人IMN疗效更佳,可显著改善患者肾功能,并改善患者脂代谢,药物方案安全性较高,具有较高应用价值。     

Nanoparticle formulation of mycophenolate mofetil achieves enhanced efficacy against hepatocellular carcinoma by targeting tumour-associated fibroblast

Hepatocellular carcinoma (HCC) is one of the most aggressive tumours with marked fibrosis. Mycophenolate mofetil (MMF) was well-established to have antitumour and anti-fibrotic properties. To overcome the poor bioavailability of MMF, this study constructed two MMF nanosystems, MMF-LA@DSPE-PEG and MMF-LA@PEG-PLA, by covalently conjugating linoleic acid (LA) to MMF and then loading the conjugate into polymer materials, PEG_5k-PLA_8k and DSPE- PEG_2k, respectively. Hepatocellular carcinoma cell lines and C57BL/6 xenograft model were used to examine the anti-HCC efficacy of nanoparticles (NPs), whereas NIH-3T3 fibroblasts and highly-fibrotic HCC models were used to explore the anti-fibrotic efficacy. Administration of NPs dramatically inhibited the proliferation of HCC cells and fibroblasts in vitro. Animal experiments revealed that MMF-LA@DSPE-PEG achieved significantly higher anti-HCC efficacy than free MMF and MMF-LA@PEG-PLA both in C57BL/6 HCC model and highly-fibrotic HCC models. Immunohistochemistry further confirmed that MMF-LA@DSPE-PEG dramatically reduced cancer-associated fibroblast (CAF) density in tumours, as the expression levels of alpha-smooth muscle actin (α-SMA), fibroblast activation protein (FAP) and collagen IV were significantly downregulated. In addition, we found the presence of CAF strongly correlated with increased HCC recurrence risk after liver transplantation. MMF-LA@DSPE-PEG might act as a rational therapeutic strategy in treating HCC and preventing post-transplant HCC recurrence.     

HPLC/Tandem Ion Trap Mass Detector Methods for Determination of Inosine Monophosphate Dehydrogenase (IMPDH) and Thiopurine Methyltransferase (TPMT)

The efficiency of Mycophenolate mofetil (MMF) and Azathioprine (AZA) as immunosuppressive agents depends on the activity of 2 enzymes, inosine monophosphate dehydrogenase (IMPDH) and thiopurine methyltransferase (TPMT) respectively. We present preliminary evaluation of nonradioactive methods that apply HPLC with ion-trap mass detection to measure the activities of IMPDH in peripheral blood mononuclear cells (PBMC) and TPMT in the erythrocytes (RBC). We found IMPDH activity of 0.9 ± 0.2 nmol/hour/10⁶ PBMC and TPMT activity of 19.9 ± 4.7 nmol/hour/ml RBC in healthy subjects. These methods, following its further validation, could be useful for monitoring the activity in a clinical and experimental setting.     

体外研究UGT2B7基因SNP rs28365062对霉酚酸酯代谢的影响

目的:体外研究尿苷二磷酸葡萄糖醛酸转移酶(UGT2B7)基因SNP rs28365062对霉酚酸酯(MMF)代谢的影响,明确该位点变异是否与MMF副作用具有潜在关系。方法:采用基因重组、定点突变技术构建UGT2B7基因SNP rs28365062不同等位基因过表达载体,POLO3000转染法将重组过表达载体转染HEK293细胞,采用液相色谱-质谱联用仪(LC/MS/MS)系统检测霉酚酸(MPA)代谢产物--酰基化葡萄糖醛酸化物(Ac MPAG)24小时的生成量来评估转染不同等位基因细胞的酶活性。结果:成功构建过表达载体p IRES2-EGFP-prom(A)和p IRES2-EGFP-prom(G)并转染至HEK293细胞。LC/MS/MS系统检测结果显示携带G等位基因的突变型UGT2B7代谢MMF产生Ac MPAG的能力降低,产物Ac MPAG 24小时的生成量仅为野生型的18.60%(P0.001)。结论:UGT2B7基因SNP rs28365062可显著影响MMF代谢产物Ac MPAG的生成,可能是导致病人对MMF产生不同程度副作用的因素之一。     

Synthesis of the immunosuppressive agent 2-morpholinoethyl mycophenolate by a lipase-catalyzed transesterification

The synthesis of 2-morpholinoethyl mycophenolate was realized by an enzymatic transesterification of simple esters of mycophenolic acid with 2-morpholinoethanol. Best results were achieved by a Candida antarctica lipase B (CAL B) catalyzed transesterification of ethyl mycophenolate in toluene. CAL B showed to selectively transform only the ethyl ester function leaving unreacted the other functional groups present on the substrate. By this way 2-morpholinoethyl mycophenolate was obtained in satisfactory yields from mycophenolic acid (84%).     

糖皮质激素联合吗替麦考酚酯分散片对系统性红斑狼疮患者的疗效及对免疫功能的影响

目的:研究糖皮质激素联合吗替麦考酚酯分散片治疗系统性红斑狼疮患者的临床疗效及对免疫功能的影响。方法:选取2014年9月至2015年8月本院收治的84例系统性红斑狼疮患者,根据投硬币法分为观察组和对照组,42例每组。对照组使用单纯的糖皮质激素,观察组在此基础上使用吗替麦考酚酯分散片。比较两组患者临床疗效,治疗前后免疫球蛋白A(IgA)、免疫球蛋白(IgG)、免疫球蛋白(IgM)、C反应蛋白(CRP)、血沉(ESR)的变化及不良反应的发生情况。结果:治疗后,观察组临床总有效率显著高于对照组(P0.05)。治疗前,两组患免疫球蛋白A(IgA)、免疫球蛋白(IgG)、免疫球蛋白(IgM)、C反应蛋白(CRP)、血沉(ESR)水平比较差异均无统计学意义(P0.05);治疗后,两组患者IgA、IgG、IgM、CRP、ESR水平均较治疗前显著降低(P0.05),与对照相比,观察组的IgA、IgG、IgM、CRP、ESR明显降低(P0.05)。两组组的不良反应率比较差异无统计学意义(P0.05)。结论:糖皮质激素联合吗替麦考酚酯分散片能有效改善系统性红斑狼疮患者的免疫功能,临床疗效良好,安全性高。     

霉酚酸酯联合糖皮质激素治疗小儿紫癜性肾炎的疗效观察

目的:探究霉酚酸酯联合糖皮质激素治疗小儿紫癜性肾炎的疗效及安全性。方法:选择2012年3月~2015年9月70例于我院就诊的紫癜性肾炎儿童,按照不同的治疗方法将其分为观察组(35例)和对照组(35例)。两组患者入院后均给予常规治疗,在此基础上观察组患者给予泼尼松联合霉酚酸酯治疗,对照组给予泼尼松联合环磷酰胺治疗。比较两组的总有效率、临床症状消失时间、生化指标、免疫功能及不良反应发生情况。结果:观察组的临床总有效率为94.29%(33/35),对照组的总有效率为85.17%(30/35),两组比较差异无统计学意义(P=0.232)。治疗后,观察组蛋白尿、血尿等临床症状消失时间与对照组比较差异无显著意义(P0.05);两组患儿的24 h蛋白定量、CD19~+水平均较治疗前显著降低,且观察组CD19~+水平显著低于对照组(P0.05),两组的血清白蛋白、总蛋白含量、CD3~+、CD3~+CD4~+水平在均较治疗前明显上升,且观察组的CD3~+、CD3~+CD4~+水平显著高于对照组(P0.05)。观察组治疗期间不良反应发生率显著低于对照组(P=0.012)。结论:霉酚酸酯联合糖皮质激素治疗小儿紫癜性肾炎的临床效果较泼尼松联合环磷酰胺治疗更好,安全性更高。     

霉酚酸酯对糖尿病大鼠肾组织单核细胞趋化蛋白-表达和炎症细胞浸润的影响

目的观察霉酚酸酯(MMF)对糖尿病大鼠肾组织单核细胞趋化蛋白-1表达和炎症细胞浸润的影响,并探讨其对肾脏的保护作用及机制。方法SD大鼠随机分为三组:对照组(C组)、糖尿病组(D组)和糖尿病治疗组(M组,20mg.kg-1.d-1)。大鼠单侧肾脏切除后,腹腔注射链脲菌素(STZ)成糖尿病模型,对照组仅注射等量缓冲液。观察12周后,检测大鼠血糖(BG)、血尿素氮(BUN)、血肌酐(Scr)、肾脏肥大指数(肾重KW/体重BW)、肌酐清除率(Ccr)和24小时尿蛋白(24Upro)。肾组织做常规光镜和电镜检查,观察组织的形态结构。用免疫组织化学方法检测肾组织中巨噬细胞抗原(CD68)和增殖细胞核抗原(PCNA)的蛋白表达。用半定量RT-PCR的方法检测肾组织中单核细胞趋化蛋白-1(MCP-1)的mRNA的表达。结果与对照组相比,糖尿病组大鼠BG、KW/BW、24Upro、BUN、Scr、Ccr均显著上升(P<0.05或0.01);肾小球系膜区相对面积和肾小球基底膜厚度均显著增加(P<0.01);肾组织内CD68和PCNA的蛋白质表达和MCP-1的mRNA表达均显著上调(P<0.05或0.01)。在糖尿病治疗组,上述指标除血糖外都被显著抑制(P<0.05或0.01)。结论在糖尿病大鼠模型中,MMF能减少尿蛋白,对糖尿病肾病有保护作用,其机制可能与其抑制炎症因子-MCP-1的表达,下调CD68和PCNA的水平,减少肾组织单核/巨噬细胞的聚集有关。     

霉酚酸酯对糖尿病大鼠肾组织单核细胞趋化蛋白-1表达和炎症细胞浸润的影响

目的观察霉酚酸酯(MMF)对糖尿病大鼠肾组织单核细胞趋化蛋白-1表达和炎症细胞浸润的影响,并探讨其对肾脏的保护作用及机制。方法SD大鼠随机分为三组:对照组(C组)、糖尿病组(D组)和糖尿病治疗组(M组,20mg.kg-1.d-1)。大鼠单侧肾脏切除后,腹腔注射链脲菌素(STZ)成糖尿病模型,对照组仅注射等量缓冲液。观察12周后,检测大鼠血糖(BG)、血尿素氮(BUN)、血肌酐(Scr)、肾脏肥大指数(肾重KW/体重BW)、肌酐清除率(Ccr)和24小时尿蛋白(24Upro)。肾组织做常规光镜和电镜检查,观察组织的形态结构。用免疫组织化学方法检测肾组织中巨噬细胞抗原(CD68)和增殖细胞核抗原(PCNA)的蛋白表达。用半定量RT-PCR的方法检测肾组织中单核细胞趋化蛋白-1(MCP-1)的mRNA的表达。结果与对照组相比,糖尿病组大鼠BG、KW/BW、24Upro、BUN、Scr、Ccr均显著上升(P<0.05或0.01);肾小球系膜区相对面积和肾小球基底膜厚度均显著增加(P<0.01);肾组织内CD68和PCNA的蛋白质表达和MCP-1的mRNA表达均显著上调(P<0.05或0.01)。在糖尿病治疗组,上述指标除血糖外都被显著抑制(P<0.05或0.01)。结论在糖尿病大鼠模型中,MMF能减少尿蛋白,对糖尿病肾病有保护作用,其机制可能与其抑制炎症因子-MCP-1的表达,下调CD68和PCNA的水平,减少肾组织单核/巨噬细胞的聚集有关。