Laboratory evaluation of twelve portable devices for medicine quality screening

BackgroundPost-market surveillance is a key regulatory function to prevent substandard and falsified (SF) medicines from being consumed by patients. Field deployable technologies offer the potential for rapid objective screening for SF medicines.Methods and findingsWe evaluated twelve devices: three near infrared spectrometers (MicroPHAZIR RX, NIR-S-G1, Neospectra 2.5), two Raman spectrometers (Progeny, TruScan RM), one mid-infrared spectrometer (4500a), one disposable colorimetric assay (Paper Analytical Devices, PAD), one disposable immunoassay (Rapid Diagnostic Test, RDT), one portable liquid chromatograph (C-Vue), one microfluidic system (PharmaChk), one mass spectrometer (QDa), and one thin layer chromatography kit (GPHF-Minilab). Each device was tested with a series of field collected medicines (FCM) along with simulated medicines (SIM) formulated in a laboratory. The FCM and SIM ranged from samples with good quality active pharmaceutical ingredient (API) concentrations, reduced concentrations of API (80% and 50% of the API), no API, and the wrong API. All the devices had high sensitivities (91.5 to 100.0%) detecting medicines with no API or the wrong API. However, the sensitivities of each device towards samples with 50% and 80% API varied greatly, from 0% to 100%. The infrared and Raman spectrometers had variable sensitivities for detecting samples with 50% and 80% API (from 5.6% to 50.0%). The devices with the ability to quantitate API (C-Vue, PharmaChk, QDa) had sensitivities ranging from 91.7% to 100% to detect all poor quality samples. The specificity was lower for the quantitative C-Vue, PharmaChk, & QDa (50.0% to 91.7%) than for all the other devices in this study (95.5% to 100%).ConclusionsThe twelve devices evaluated could detect medicines with the wrong or none of the APIs, consistent with falsified medicines, with high accuracy. However, API quantitation to detect formulations similar to those commonly found in substandards proved more difficult, requiring further technological innovation.     

A comparative field evaluation of six medicine quality screening devices in Laos

BackgroundMedicine quality screening devices hold great promise for post-market surveillance (PMS). However, there is little independent evidence on their field utility and usability to inform policy decisions. This pilot study in the Lao PDR tested six devices’ utility and usability in detecting substandard and falsified (SF) medicines.Methodology/principal findingsObservational time and motion studies of the inspections by 16 Lao medicine inspectors of 1) the stock of an Evaluation Pharmacy (EP), constructed to resemble a Lao pharmacy, and 2) a sample set of medicines (SSM); were conducted without and with six devices: four handheld spectrometers (two near infrared: MicroPHAZIR RX, NIR-S-G1 & two Raman: Progeny, Truscan RM); one portable mid-infrared spectrometer (4500a), and single-use paper analytical devices (PAD). User experiences were documented by interviews and focus group discussions.Significantly more samples were wrongly categorised as pass/fail with the PAD compared to the other devices in EP inspections (p<0.05). The numbers of samples wrongly classified in EP inspections were significantly lower than in initial visual inspections without devices for 3/6 devices (NIR-S-G1, MicroPHAZIR RX, 4500a). The NIR-S-G1 had the fastest testing time per sample (median 93.5 sec, p<0.001). The time spent on EP visual inspection was significantly shorter when using a device than for inspections without devices, except with the 4500a, risking missing visual clues of samples being SF. The main user errors were the selection of wrong spectrometer reference libraries and wrong user interpretation of PAD results. Limitations included repeated inspections of the EP by the same inspectors with different devices and the small sample size of SF medicines.Conclusions/significanceThis pilot study suggests policy makers wishing to implement portable screening devices in PMS should be aware that overconfidence in devices may cause harm by reducing inspectors’ investment in visual inspection. It also provides insight into the advantages/limitations of diverse screening devices in the hands of end-users.     

Evaluation of portable devices for medicine quality screening: Lessons learnt,recommendations for implementation,and future priorities

Céline Caillet and co-authors discuss a Collection on use of portable devices for the evaluation of medicine quality and legitimacy.

Summary points

• Portable devices able to detect substandard and falsified medicines are vital innovations for enhancing the inspection of medicines in pharmaceutical supply chains and for timely action before they reach patients. Such devices exist, but there has been little to no independent scientific evidence of their accuracy and cost-effectiveness to guide regulatory authorities in choosing appropriate devices for their settings.
• We tested 12 portable devices, evaluated their diagnostic performances and the resources required to use each device in a laboratory.
• We then assessed the utility and usability of the devices in medicine inspectors’ hands in a pharmacy mimicking a real-life Lao pharmacy.
• We then assessed the health and economic benefits of using portable devices compared to not using them in a low- to middle-income setting.
• Here, we discuss the conclusions and practical implications of the multiphase study discussed in this Collection. We discuss the results, highlight the evidence gaps, and provide recommendations on the key aspects to consider in the implementation of portable devices and their main advantages and limitations.

Global concerns over the quality of medicines, especially in low- and middle-income countries (LMICs) are exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic [1,2]. The World Health Organisation (WHO) estimated that 10.5% of medicines in LMICs may be substandard or falsified (SF) [3]. “Prevention, detection, and response” to SF medical products are strategic priorities of WHO to contribute to effective and efficient regulatory systems [4]. Numerous portable medicine screening devices are available on the market, holding great hope for detection of SF medicines in an efficient and timely manner, and, therefore, might serve as key detection tools to inform prevention and response [5,6]. Screening devices have the potential to rapidly identify suspected SF medical products, giving more objective selection for reference assays, reducing the financial and technical burden. However, little is known regarding how well the existing devices fulfil their functions and how they could be deployed within risk-based postmarketing surveillance (rb-PMS) systems [5–7].We conducted, during 2016 to 2018, a collaborative multiphase exploratory study aimed at comparing portable screening devices. This paper accompanies 4 papers in this PLOS Collection “A multiphase evaluation of portable screening devices to assess medicines quality for national Medicines Regulatory Authorities.” The first article introduced the multiphase study [8]. In brief, 12 devices (S1 Table) were first evaluated in a laboratory setting [9], to select the most field-suitable devices for further evaluation of their utility/usability by Lao medicines inspectors [10]. Cost-effectiveness analysis of their implementation for rb-PMS in Laos was also conducted [11]. The results of these 3 phases were discussed in a multistakeholder meeting in 2018 in Vientiane, Lao PDR (S1 Text). The advantages/disadvantages, cost-effectiveness, and optimal use of screening devices in medicine supply chains were discussed to develop policy recommendations for medicines regulatory authorities (MRAs) and other institutions who wish to implement screening technologies. A summary of the main results of the multiphase study is presented in S2 Table.As far as we are aware, this is the first independent investigation comparing the accuracy and practical use from a public health perspective, of a diverse set of portable medicine quality screening devices. The specific objective(s) for which the portable screening technologies are implemented, their advantages/limitations, costs and logistics, and the development of detailed standard operating procedures and training programmes are key points to be carefully addressed when considering selection and deployment of screening technologies within specific rb-PMS systems (Fig 1).Open in a separate windowFig 1Major proposed considerations for the selection and implementation of medicine quality screening device.Each circle represents a key consideration when purchasing a screening device, grouped by themes (represented by heptagons). When the shapes overlap, the considerations are connected. For example, standard operating procedures are needed for the implementation of devices and should include measures for user safety. The circle diameters are illustrative.Here, we utilise this research and related literature to discuss the evidence, gaps, and recommendations, complementary to those recently published by the US Pharmacopeial Convention [12]. These discussions can inform policy makers, non-governmental organisations, wholesalers/distributors, and hospital pharmacies considering the implementation of such screening devices. We discuss unanswered research questions that require attention to ensure that the promise these devices hold is realised.     

Implementation of field detection devices for antimalarial quality screening in Lao PDR—A cost-effectiveness analysis

Substandard and falsified (SF) antimalarials have devastating consequences including increased morbidity, mortality and economic losses. Portable medicine quality screening devices are increasingly available, but whether their use for the detection of SF antimalarials is cost-effective is not known. We evaluated the cost-effectiveness of introducing such devices in post-market surveillance in pharmacies in Laos, conservatively focusing on their outcome in detecting SF artemisinin-based combination therapies (ACTs). We simulated the deployment of six portable screening devices: two handheld near-infrared [MicroPHAZIR RX, NIR-S-G1], two handheld Raman [Progeny, TruScan RM]; one portable mid-infrared [4500a FTIR] spectrometers, and single-use disposable paper analytical devices [PADs]. We considered two scenarios with high and low levels of SF ACTs. Different sampling strategies in which medicine inspectors would test 1, 2, or 3 sample(s) of each brand of ACT were evaluated. Costs of inspection including device procurement, inspector time, reagents, reference testing, and replacement with genuine ACTs were estimated. Outcomes were measured as disability adjusted life years (DALYs) and incremental cost-effectiveness ratios were estimated for each device compared with a baseline of visual inspections alone. In the scenario with high levels of SF ACTs, all devices were cost-effective with a 1-sample strategy. In the scenario of low levels of SF ACTs, only four devices (MicroPHAZIR RX, 4500a FTIR, NIR-S-G1, and PADs) were cost-effective with a 1-sample strategy. In the multi-way comparative analysis, in both scenarios the NIR-S-G1 testing 2 samples was the most cost-effective option. Routine inspection of ACT quality using portable screening devices is likely to be cost-effective in the Laos context. This work should encourage policy-makers or regulators to further investigate investment in portable screening devices to detect SF medicines and reduce their associated undesired health and economic burdens.     

UV-A screening in plants determined using a new portable fluorimeter

UV screening by plant surfaces can be determined by exposing plant organs to UV radiation and measuring the chlorophyll (Chl) fluorescence elicited. From this fluorescence, the UV transmittance can be derived: the more intense the screening the lower the reporter Chl fluorescence and the lower the UV transmittance. The relationships between UV screening at 375 nm, as determined in the field by a portable UV-A-PAM fluorimeter, and UV screening at 314 and 360 nm, measured in the laboratory with the non-portable XE-PAM fluorimeter, were investigated in leaves of grapevine (Vitis vinifera L. cv. Bacchus) and barley (Hordeum vulgare cv. Ricarda), as well as in white grape berries. With leaves, linear trends were observed between XE-PAM measurements at 314 nm and UV-A-PAM measurements at 375 nm but the relationship between transmittance at 360 and 375 nm in barley was curved: a simple model calculation suggests that this curvi-linearity arises from particularly weak absorbance of barley flavonoids at 375 nm relative to absorbance at 360 nm. Transmittance values at 314 nm plotted against 375 nm yielded a much smaller slope in grapevine leaves than in barley leaves, which was attributed to screening in the short-wavelength UV by hydroxycinnamic acids in the former but not in the latter species. With grape berries, a poor correlation was detected between transmittances at 314 and 375 nm which might arise from high scattering of UV radiation at the berry surface. Such artefacts appear to be confined to the UV-B region, as berry transmittance at 360 nm correlated very well with that at 375 nm. Thus, assessment of UV screening in the field at short UV wavelengths using 375 nm readings from a UV-A-PAM fluorimeter is possible provided that information is available on the relationship between the transmittance at the UV wavelength of interest and at 375 nm for the sample tissue being investigated.     

Strategy for analysis and screening of bioactive compounds in traditional Chinese medicines

Traditional Chinese medicines (TCMs), due to their long time clinic test and reliable therapeutic efficacy, are attracting increased global attention served as excellent pools of bioactive compounds for the discovery of new drugs. However, hundreds or even thousands of components are usually contained in traditional Chinese medicines and only a few compounds are responsible for the pharmaceutical and/or toxic effects. The large numbers of other components in traditional Chinese medicines make the screening and analysis of the bioactive components extremely difficult. By the way, the combination effect of bioactive components on the pharmacological activity makes it very difficult to clear the therapeutic mechanism of TCMs. Therefore, some strategies have to design for screening of bioactive compounds in traditional Chinese medicines, which further leads to disclose the therapeutic mechanism of TCMs in molecular level. The review will summarize the present state of the art of screening strategy for active compounds in traditional Chinese medicines, and the chromatography methods for screening and analysis of bioactive compounds in traditional Chinese medicines will be emphasized.     

Cell-based high-throughput proliferation and cytotoxicity assays for screening traditional Chinese herbal medicines

A simple, reliable, high-throughput screening method was developed and used to assess the pharmaceutical effects of extracts of traditional Chinese herbal medicines (TCHMs). This method is based on 3-dimensional (3-D) cultures of mouse embryonic stem (mES) and human colon cancer and breast cancer cells expressing enhanced green fluorescent protein (EGFP) in polyethylene terephthalate (PET) fibrous scaffolds on modified 384-well plates with online monitoring of culture fluorescence for dynamic responses of cells to drugs present in culture media. Cell responses to deoxycholic acid and the extracts of 3 TCHMs (Ganoderma lucidum spores, Ginkgo biloba, and Epimedium brevicornum) at various concentrations were investigated for their effects on proliferation and cytotoxicity. The screening results, i.e., the growth responses of cancer cells to those drugs, were consistent with what have been reported in the literature, confirming the reliability of the new screening approach. Different from previous screening methods for both TCHMs and western medicines that used animal models or 2-D cell-based assays with single cell lines, this 3-D cell-based screening method employs both cancer and normal cells and thereby provides a way for quick, direct evaluation of the anticancer effects of TCHMs. This method also offers assessment on the side effects of TCHMs.     

10种中草药提取物体外抗铜绿假单胞菌作用研究

通过对粗糠柴等10种中草药采用80%乙醇室温下浸渍制备的提取物进行体外抗铜绿假单胞菌及其耐药菌活性研究,并采取药敏纸片法测定临床分离菌株的耐药性。结果表明:这10种中草药80%乙醇提取物中,粗糠柴的乙酸乙酯层对铜绿假单胞菌标准菌及其耐药菌的抑菌效果最好,其抑菌圈直径范围在10~17 mm之间,MIC范围在0.125~0.5 mg·mL~(-1)之间,MBC范围在0.5~1 mg·mL~(-1)之间;正丁醇层、水层的抑菌活性较乙酸乙酯层弱,石油醚层对铜绿假单胞菌没有效果。而小叶藤黄、滇南红厚壳、续随子的乙酸乙酯层,巴豆、罗汉松、肉桂醇提物对铜绿假单胞菌及其耐药菌株有较弱抗菌活性;滇南红厚壳的正丁醇层、续随子乙酸乙酯层以及大八角和郁金的醇提物对铜绿假单胞菌及其耐药菌株均无活性。从这些数据中可以得出,粗糠柴的乙酸乙酯层、正丁醇层和水层对铜绿假单胞菌及其耐药菌有较好的抑菌活性,尤以乙酸乙酯层活性最好,而粗糠柴的石油醚层没有活性。     

Electromyographic analysis of abdominal muscle activity using portable abdominal exercise devices and a traditional crunch

The purpose of this study was to compare the abdominal muscle activity elicited while using 4 portable abdominal training devices vs. a traditional crunch. Thirty-three adults participated in this study. The exercise devices tested included the Ab Roller Plus, Torso Track 2, AB-DOer Pro, and the Perfect Abs. All subjects were tested on the Perfect Abs in both a seated and supine position using low-, medium-, and high-resistance bands. The Torso Track 2 was also tested at low- and high-resistance settings. Surface electromyography (EMG) was recorded from the upper and lower portions of the rectus abdominis, external oblique, and the rectus femoris during each repetition. Statistical analyses were performed on the mean EMG values using a repeated analysis of variance (ANOVA) procedure. There was no significant difference in abdominal muscle activity between the Ab Roller Plus, the Torso Track 2 (high resistance), and a traditional crunch. The mean abdominal muscle activity was significantly lower than a normal crunch, however, when using the AB-DOer, Torso Track (low resistance), and the Perfect Abs seated with the low-resistance band. In contrast, the Perfect Abs, when used in the supine position with the medium- and high-resistance bands, elicited significantly greater mean abdominal muscle activity than a crunch. Of the 4 devices tested, only the Perfect Abs when used in the supine position with the medium- and high-resistance bands, elicited more abdominal activity than a crunch. The results suggest that portable abdominal devices are most effective if they not only mimic the mechanics of a traditional crunch, but also provide external resistance to increase the involvement of the abdominal musculature.     

The histopathological evaluation of the local tolerance of alendronate containing medicines

INTRODUCTION: In order to be effective, treatment for osteoporosis must be long-term. Unfortunately, according to clinical trials and clinical practice the most frequent cause of patient resignation from the treatment is adverse reactions to the medications. In the case of bisphosphonates they are most frequently connected with irritant impact of the drug on gastrointestinal mucosa. The aim of our study was to answer the question whether alendronate tablets coated with a thin neutral layer may protect gastrointestinal mucosa from the irritant effects of the active substance. MATERIAL AND METHODS: Three types of tablets were administered into the cheek pouches of 18 Syrian hamsters (divided into 3 experimental groups: I, II, III) i.e. regular alendronate tablets, coated alendronate tablets and placebo. The tablets were applied for 4 minutes a day on 4 consecutive days. 24 hours after the last application, the animals were sacrificed and segments of buccal tissue were taken for histopathological examination. Oral tissue reaction was assessed using the microscopic examination grading system developed by ISO. The following adverse changes of the tissue were recorded: epithelial lesions, leucocyte infiltration, vascular congestion and oedema. Later the irritation index was calculated. RESULTS: The irritation index was 11.0 (moderately irritant), 0.0 and 0.0 (none-irritant), in each group respectively. CONCLUSION: It appears that the administration of the coated alendronate tablets reduces the frequency and intensity of the local adverse events from the gastrointestinal tract.     

Application of 2-D DIGE to survey the quality of biological medicines

2-D DIGE was used to investigate 'fingerprint proteins' in biological medicines. A presumably non-originator human albumin was analysed, and the 2-D DIGE patterns of the non-genuine and the authentic product were compared. The products could be clearly distinguished based on the pattern of minor components, which represent plasma proteins and degradation products remaining in the final products after fractionation and purification. The approach demonstrated that 2-D DIGE is an excellent tool for the analysis of biologicals of different sources and for ensuring the identity and quality of blood products.     

Depression screening as a quality indicator

Objective Although practice guidelines for depression screening are evidence based, with their development relying on reviews of controlled studies, their adaptation and use as quality indicators have not been subject to rigorous study. This paper will therefore review the evidence supporting this practice.Methods A rational evaluation was carried out on both controlled studies and other sources of evidence related to the technical, clinical and policy assumptions underlying the use of depression screening guidelines as quality indicators.Results 1) Technical assumptions: depression screening could be used as a quality indicator. Current information technology does not allow accurate determination of who would benefit from being screened, whether they actually were screened, or the optimal percentage that should be screened. 2) Clinical assumptions: depression screening would improve outcomes. The evidence suggests that although depression screening might increase the diagnosis of depression, depressed patients so recognised tend to be less ill, less in need of treatment, or less likely to benefit from treatment, while screening, in the absence of other interventions, does not improve outcomes. 3) Policy assumptions: depression screening should be a focus of quality improvement. However, relative to other preventative measures, depression screening is a low priority. It does not meet usual cost-effectiveness criteria. There are more robust interventions for depression (i.e. collaborative care) that could be a focus of quality improvement efforts.Conclusion Although routine depression screening may be an acceptable practice guideline, its use as a quality measure is not supported.     

4C-克隆筛选过程中的质量控制

环形染色体构象俘获(Circular chromosome conformation capture,4C)是一种高通量研究细胞染色体相互作用、空间构象的技术。文章通过模拟的4C样品,优化反向PCR条件,建立了高效、特异的扩增方法,对4C克隆筛选等后续步骤进行严格的质量控制并对该方法的可行性进行了实例验证。该4C-克隆筛选方法作为4C方法的质量控制标准,具有重要的指导和监测作用。     

Comparative evaluation of seven cell collection devices for cervical smears

OBJECTIVE: To compare the most commonly used cervical sampling devices. STUDY DESIGN: We examined seven cytology sampling devices (Cytobrush, Cervex brush, Szalay spatula, Papex spatula, WrGKK spatula [main social security agency in Vienna], cotton swab and loop). Eight hundred smears were assessed for even distribution of cells, percentage of slide surface covered with cells, and presence and number of endocervical cells. RESULTS: Even distribution of cells was best with the WrGKK spatula. Percentage of slide surface covered with evaluable cells was best with the Cytobrush. Highest ranking for the presence of endocervical cells was found for the Cytobrush. Cotton swabs and loop showed inferior results in all categories. CONCLUSION: The use of cervical cell sampling devices showing the best cytologic results improves the interpretation and validity of cervical smears. Our results suggest that cotton swabs and loops should not be used for cervical cell sampling.     

抗体成药性筛选流程及评价策略

自1986年OKT3作为第一个治疗性单克隆抗体获批上市后,抗体技术及抗体药物迅猛发展。单克隆抗体、抗体片段、双(多)特异性抗体、融合蛋白、纳米抗体以及抗体偶联药物(antibody-drug conjugates, ADCs)等推陈出新,在肿瘤、血液、免疫、呼吸和代谢等相关疾病的治疗领域发挥着举足轻重的作用。抗体药物的发现过程,是通过多轮生物学功能评估和可成药性评估,筛选出具有安全、有效、稳定和可工艺放大的最佳候选序列,从而提高药物开发和临床研究的效率及成功率。抗体药物发现阶段的“成药性筛选与评估”已日益受到关注和重视,从药物发现和设计、先导分子筛选到候选分子确认,可及时发现分子潜在的物理化学风险因素,并评估可控性,保证后续药物开发过程中的质量稳定性。本文对抗体发现阶段的成药性筛选评估流程进行了分类和定义,涉及单克隆抗体、双特异性抗体、纳米抗体和ADCs等相关技术和药物形式,同时总结了成药性筛选评估中应重点关注的质量属性和高通量检测技术;系统性地阐述成药性开发流程和策略,为不断涌现的创新型药物的成药性筛选评估提供参考,大幅提高抗体药物开发的效率和成功率。     

A review of Doppler ultrasound quality assurance protocols and test devices

In this paper, an overview of Doppler ultrasound quality assurance (QA) testing will be presented in three sections. The first section will review the different Doppler ultrasound parameters recommended by professional bodies for use in QA protocols. The second section will include an evaluation and critique of the main test devices used to assess Doppler performance, while the final section of this paper will discuss which of the wide range of test devices have been found to be most suitable for inclusion in Doppler QA programmes. Pulsed Wave Spectral Doppler, Colour Doppler Imaging QA test protocols have been recommended over the years by various professional bodies, including the UK's Institute of Physics and Engineering in Medicine (IPEM), the American Institute for Ultrasound in Medicine (AIUM), and the International Electrotechnical Commission (IEC). However, despite the existence of such recommended test protocols, very few commercial or research test devices exist which can measure the full range of both PW Doppler ultrasound and colour Doppler imaging performance parameters, particularly quality control measurements such as: (i) Doppler sensitivity (ii) colour Doppler spatial resolution (iii) colour Doppler temporal resolution (iv) colour Doppler velocity resolution (v) clutter filter performance and (vi) tissue movement artefact suppression. In this review, the merits of the various commercial and research test devices will be considered and a summary of results obtained from published studies which have made use of some of these Doppler test devices, such as the flow, string, rotating and belt phantom, will be presented.     

Cell‐based screening of traditional chinese medicines for proliferation enhancers of mouse embryonic stem cells

A high‐throughput cell‐based method was developed for screening traditional Chinese herbal medicines (TCHMs) for potential stem cell growth promoters. Mouse embryonic stem (mES) cells expressing enhanced green fluorescent protein (EGFP) were cultured in growth media supplemented with various TCHM extracts. The dosage‐dependent effects of TCHM extracts on cell growth, including proliferation and cytotoxicity, were assessed via EGFP fluorescence measurement. Seven TCHMs were investigated, and among them Panax notoginseng (PN), Rhizoma Atractylodis macrocephalae, Rhizoma chuanxiong, and Ganoderma lucidum spores (GLS) showed potential to improve mES cell proliferation. Eleven mixtures of these four TCHMs were then studied, and the results showed that the mixture of PN and GLS had the strongest growth promoting effect, increasing the specific growth rate of mES cells by 29.5% at a low dosage of 0.01% (wt/vol) PN/GLS (P < 0.01) and 34.2% at 0.1% (wt/vol) PN/GLS (P < 0.05) compared to the control. The growth promoting effect of PN/GLS was further confirmed with ES cells cultured in spinner flasks. A 29.3‐fold increase in the total cell number was achieved in the medium supplemented with 0.01% PN/GLS after 5 days, while the control culture only gave a 16.8‐fold increase. This cell‐based screening method thus can provide an efficient and high‐throughput way to explore potential stem cell growth promoters from TCHMs. © 2013 American Institute of Chemical Engineers Biotechnol. Prog., 29:738–744, 2013