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Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam

Growth and development affect drug‐metabolizing enzyme activity thus could alter the metabolic profile of a drug. Traditional studies to create metabolite profiles and study the routes of excretion are unethical in children due to the high radioactive burden. To overcome this challenge, we aimed to...

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Autores principales: van Groen, Bianca D., van Duijn, Esther, de Vries, Arjan, Mooij, Miriam G., Tibboel, Dick, Vaes, Wouter H. J., de Wildt, Saskia N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689753/
https://www.ncbi.nlm.nih.gov/pubmed/32386327
http://dx.doi.org/10.1002/cpt.1884
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author van Groen, Bianca D.
van Duijn, Esther
de Vries, Arjan
Mooij, Miriam G.
Tibboel, Dick
Vaes, Wouter H. J.
de Wildt, Saskia N.
author_facet van Groen, Bianca D.
van Duijn, Esther
de Vries, Arjan
Mooij, Miriam G.
Tibboel, Dick
Vaes, Wouter H. J.
de Wildt, Saskia N.
author_sort van Groen, Bianca D.
collection PubMed
description Growth and development affect drug‐metabolizing enzyme activity thus could alter the metabolic profile of a drug. Traditional studies to create metabolite profiles and study the routes of excretion are unethical in children due to the high radioactive burden. To overcome this challenge, we aimed to show the feasibility of an absorption, distribution, metabolism, and excretion (ADME) study using a [(14)C]midazolam microtracer as proof of concept in children. Twelve stable, critically ill children received an oral [(14)C]midazolam microtracer (20 ng/kg; 60 Bq/kg) while receiving intravenous therapeutic midazolam. Blood was sampled up to 24 hours after dosing. A time‐averaged plasma pool per patient was prepared reflecting the mean area under the curve plasma level, and subsequently one pool for each age group (0–1 month, 1–6 months, 0.5–2 years, and 2–6 years). For each pool [(14)C]levels were quantified by accelerator mass spectrometry, and metabolites identified by high resolution mass spectrometry. Urine and feces (n = 4) were collected up to 72 hours. The approach resulted in sufficient sensitivity to quantify individual metabolites in chromatograms. [(14)C]1‐OH‐midazolam‐glucuronide was most abundant in all but one age group, followed by unchanged [(14)C]midazolam and [(14)C]1‐OH‐midazolam. The small proportion of unspecified metabolites most probably includes [(14)C]midazolam‐glucuronide and [(14)C]4‐OH‐midazolam. Excretion was mainly in urine; the total recovery in urine and feces was 77–94%. This first pediatric pilot study makes clear that using a [(14)C]midazolam microtracer is feasible and safe to generate metabolite profiles and study recovery in children. This approach is promising for first‐in‐child studies to delineate age‐related variation in drug metabolite profiles.
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spelling pubmed-76897532020-12-09 Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam van Groen, Bianca D. van Duijn, Esther de Vries, Arjan Mooij, Miriam G. Tibboel, Dick Vaes, Wouter H. J. de Wildt, Saskia N. Clin Pharmacol Ther Research Growth and development affect drug‐metabolizing enzyme activity thus could alter the metabolic profile of a drug. Traditional studies to create metabolite profiles and study the routes of excretion are unethical in children due to the high radioactive burden. To overcome this challenge, we aimed to show the feasibility of an absorption, distribution, metabolism, and excretion (ADME) study using a [(14)C]midazolam microtracer as proof of concept in children. Twelve stable, critically ill children received an oral [(14)C]midazolam microtracer (20 ng/kg; 60 Bq/kg) while receiving intravenous therapeutic midazolam. Blood was sampled up to 24 hours after dosing. A time‐averaged plasma pool per patient was prepared reflecting the mean area under the curve plasma level, and subsequently one pool for each age group (0–1 month, 1–6 months, 0.5–2 years, and 2–6 years). For each pool [(14)C]levels were quantified by accelerator mass spectrometry, and metabolites identified by high resolution mass spectrometry. Urine and feces (n = 4) were collected up to 72 hours. The approach resulted in sufficient sensitivity to quantify individual metabolites in chromatograms. [(14)C]1‐OH‐midazolam‐glucuronide was most abundant in all but one age group, followed by unchanged [(14)C]midazolam and [(14)C]1‐OH‐midazolam. The small proportion of unspecified metabolites most probably includes [(14)C]midazolam‐glucuronide and [(14)C]4‐OH‐midazolam. Excretion was mainly in urine; the total recovery in urine and feces was 77–94%. This first pediatric pilot study makes clear that using a [(14)C]midazolam microtracer is feasible and safe to generate metabolite profiles and study recovery in children. This approach is promising for first‐in‐child studies to delineate age‐related variation in drug metabolite profiles. John Wiley and Sons Inc. 2020-06-27 2020-11 /pmc/articles/PMC7689753/ /pubmed/32386327 http://dx.doi.org/10.1002/cpt.1884 Text en © 2020 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Research
van Groen, Bianca D.
van Duijn, Esther
de Vries, Arjan
Mooij, Miriam G.
Tibboel, Dick
Vaes, Wouter H. J.
de Wildt, Saskia N.
Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam
title Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam
title_full Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam
title_fullStr Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam
title_full_unstemmed Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam
title_short Proof of Concept: First Pediatric [(14)C]microtracer Study to Create Metabolite Profiles of Midazolam
title_sort proof of concept: first pediatric [(14)c]microtracer study to create metabolite profiles of midazolam
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689753/
https://www.ncbi.nlm.nih.gov/pubmed/32386327
http://dx.doi.org/10.1002/cpt.1884
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