En transplantation d'organes solides ou en greffe de moelle osseuse, la ciclosporine et letacrolimus ont prouvé leur efficacité. Ils sont cependant de maniement délicat du fait d'unintervalle thérapeutique étroit et d'une grande variabilité pharmacocinétique inter et intraindividuelle.Un suivi thérapeutique et une adaptation des posologies de ces médicaments sontnécessaires pour diminuer le risque de rejet et limiter leur toxicité.Un modèle PBPK est construit à partir de considérations anatomiques, physiologiques etbiochimiques. Il permet d'apporter des informations sur les cinétiques tissulaires et sur lesrépercussions des altérations physiologiques ou pathologiques.Les modalités optimales d'administration de la ciclosporine en greffe de moelle osseusepédiatrique, ainsi que les zones thérapeutiques à atteindre, font l'objet de débats. Un modèlePBPK-PD pour la ciclosporine construit à partir de données chez le rat puis extrapolé etvalidé chez l'homme a permis d'estimer l'exposition à la ciclosporine dans les organes ciblesde la GVH, de comparer les modalités d'administration en perfusion intraveineuse, et dedéfinir des concentrations cibles en fonction des indications. L'adaptation posologique du tacrolimus en transplantation hépatique par la méthodeBayésienne reste relativement imprécise dans la période initiale après la greffe, parce que lesfacteurs de variabilité sont imparfaitement connus. Un modèle PBPK a été construit et évaluéafin de rechercher les covariables pertinentes par une approche bottom-up : la fonctionhépatique, l'hématocrite, le génotype du cytochrome P450 3A5 du donneur, la fraction libre etcertaines comédications ont été retrouvées. / In solid organ or bone marrow transplantation, cyclosporine and tacrolimus have proven theireffectiveness. However, their handling remains difficult because of a narrow therapeuticwindow and high inter- and intra-individual pharmacokinetic variabilities. Therapeutic drugmonitoring and dose adjustments of these drugs are necessary to reduce the risk of rejectionand minimize their toxicity.A PBPK model is built from anatomical, physiological and biochemical data. It can provideinformation on the kinetics in tissues and on the effects of physiological or pathologicalalterations.How to best administer cyclosporine in pediatric bone marrow transplantation, as well astherapeutic ranges to achieve, are discussed. A PBPK-PD model for cyclosporin built fromdata in the rat and then extrapolated and validated in humans was used to estimate exposure tocyclosporine in the target organs of GVHD, to compare schedules of administration byintravenous infusion, and to define target blood concentration based on therapeuticindications.Dose adjustment of tacrolimus in liver transplant patients by the Bayesian method is relativelyinaccurate in the initial period after transplantation because factors of variability areincompletly understood. A PBPK model was constructed and evaluated in order to findrelevant covariates by a bottom-up approach. Liver function, hematocrit, cytochrome P4503A5 genotype of the donor, the unbound fraction and some comedications were found. Newdosing regimen recommendations have been developed from this model.

Thesis advisor: Julie H. Mortimer / The unifying theme of this dissertation is the growing importance of pharmaceutical products in health care and in society more broadly. The first two chapters use structural and reduced-form models to study the effects of various policies on the choice and utilization of prescription drugs. The third chapter surveys the empirical literature on the competitive effects of a class of pricing arrangements used in the pharmaceutical and many other industries. Chapter 1. One of the criticisms leveled against direct-to-consumer advertising of prescription drugs is that it overemphasizes the use of pharmaceuticals at the expense of other forms of treatment. In “Choice of Depression Treatment: Advertising Spillovers in a Model with Complementarity,” I study how antidepressant TV ads affect demand for psychotherapy. Antidepressant advertising can increase demand for therapy if the products are complements or if advertising has spillover effects. To disentangle the different channels, I develop a discrete-choice demand model that allows for complementarity between products, advertising spillovers, and flexible unobserved preference heterogeneity. Individual-level panel data on treatment choices and price variation allow me to separately identify complementarity and correlated preferences, whereas the average price of TV advertising, used as an instrument, identifies the causal effect of antidepressant ads on demand for each product. The results indicate that even though antidepressants and psychotherapy are substitutes, drug advertising increases demand for therapy through a spillover effect. Allowing for time-invariant and time-varying unobservables that can be correlated across products critically affects the estimated degree of complementarity and advertising elasticities. Chapter 2. While prescription drugs have enabled the cost-effective treatment of a myriad of diseases, many pharmaceuticals come with potential for abuse. The growing use of opioid medications for chronic pain led to widespread misuse, addiction, and skyrocketing overdose death rates. In “Did Plain-Vanilla Prescription Drug Monitoring Programs Reduce Opioid Use? Evidence from Privately Insured Patients,” I explore whether prescription drug monitoring programs (PDMPs) with no registration or use mandates were effective in reducing the utilization of opioid prescription drugs. Exploiting the staggered introduction of such programs between 2008 and 2010, I use difference-in-differences to estimate their causal effect on the number of prescriptions, days supply, and dosage per capita. Based on data from privately insured adults, the estimation results reveal that PDMPs successfully reduced opioid utilization, especially of high-dosage prescriptions. A battery of robustness checks suggests that the estimated effects are caused by the PDMPs and not by confounding factors such as broader trends in health care, attrition, out-of-state purchases, or other anti-opioid policies. Chapter 3. The assumption that buyers pay the same price for each unit of the good they purchase underlies many economic analyses. However, linear pricing is one of many pricing arrangements used in practice. In “Empirical Evidence on Conditional Pricing Practices: A Review,” Julie Holland Mortimer and I review the existing empirical studies on the competitive impact of conditional pricing practices (CPPs), under which the price of a product may depend on a quantity, share, bundling, or other requirement. Examples of CPPs include all-units and loyalty discounts, full-line forcing contracts, and exclusivity arrangements. A common thread unifying the empirical literature is that CPPs often have both procompetitive and anticompetitive effects and that their net effect may depend on the details of the arrangements and the characteristics of the markets in which they are used. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

<p>Suboptimal dosing of anti-microbial agents increases the likelihood of therapeutic failure and resistance. Dosing optimization, while an attractive approach to combat these issues, is difficult to implement due to the different pharmacokinetics of each individual. These limitations highlight the inadequacies of a “standardized” dosing strategy. Therapeutic drug monitoring (TDM) provides a tailored treatment for individuals while avoiding adverse side effects from compounds with a narrow therapeutic window where elevated concentrations of a drug cause organ toxicity. This strategy involves accurately measuring the concentration of the analyte and interpreting the results based on pharmacokinetic parameters. Clinicians then draw conclusions regarding dose adjustment for their patient. However, TDM is expensive and difficult to perform because measurements occur in biofluids. Rapid and robust methods are necessary to quantify antimicrobial agents at the institutional level to guide patient care toward improved outcomes in serious infection. Paper spray ionization (PS), an emerging ambient ionization technique for clinical settings, demonstrations a wide versatility both in analyte variety and applications. This technique offers a rapid, accurate method to analyze these compounds with low rates of false positives even when multiplexing.</p><p><br></p><p>The work herein explains the method development of assays for TDM of various antimicrobial agents. Chapters two and three describe ways to improve the quantitative capability of paper spray through substrate pre-treatment, modification, and manipulation of key factors. Chapter four describes real-world applications for paper spray utility in clinical settings with the cross-validation of antifungal agents against a “gold standard” method. The final chapter, while not clinical based, describes the method development process for a LC-MS/MS assay to detect urobilinoids in fly guts.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Suboptimal dosing of anti-microbial agents increases the likelihood of therapeutic failure and resistance. Dosing optimization, while an attractive approach to combat these issues, is difficult to implement due to the different pharmacokinetics of each individual. These limitations highlight the inadequacies of a “standardized” dosing strategy. Therapeutic drug monitoring (TDM) provides a tailored treatment for individuals while avoiding adverse side effects from compounds with a narrow therapeutic window where elevated concentrations of a drug cause organ toxicity. This strategy involves accurately measuring the concentration of the analyte and interpreting the results based on pharmacokinetic parameters. Clinicians then draw conclusions regarding dose adjustment for their patient. However, TDM is expensive and difficult to perform because measurements occur in biofluids. Rapid and robust methods are necessary to quantify antimicrobial agents at the institutional level to guide patient care toward improved outcomes in serious infection. Paper spray ionization (PS), an emerging ambient ionization technique for clinical settings, demonstrations a wide versatility both in analyte variety and applications. This technique offers a rapid, accurate method to analyze these compounds with low rates of false positives even when multiplexing. The work herein explains the method development of assays for TDM of various antimicrobial agents. Chapters two and three describe ways to improve the quantitative capability of paper spray through substrate pre-treatment, modification, and manipulation of key factors. Chapter four describes real-world applications for paper spray utility in clinical settings with the cross-validation of antifungal agents against a “gold standard” method. The final chapter, while not clinical based, describes the method development process for a LC-MS/MS assay to detect urobilinoids in fly guts.

<p>Metotreksat kao antagonista folne kiseline ima &scaron;iroku upotrebu za lečenje brojnih maligniteta, primenjen u visokim dozama i u&nbsp; kombinciji&nbsp; sa leukovorinom. Iako&nbsp; je&nbsp; terapija&nbsp; visokim&nbsp; dozama&nbsp; metotreksata drastično pobolj&scaron;ala&nbsp; prognozu pacijenata sa malignitetom, te&scaron;ki neželjeni efekti terapije predstavljaju stalan klinički problem. Ciljevi istraživanja bili su određivanje serumske koncentracije metotreksata i izračunavanje farmakokinetičkih&nbsp; parametara&nbsp; metotreksata kod dece obolele od malignih&nbsp; bolesti&nbsp; koja su na terapiji visokim dozama metotreksata (2&nbsp; g/m² i&nbsp; 5&nbsp; g/m² ); ispitivanje postojanja uticaja primenjene doze metotreksata, demografskih i kliničkih karakteristika ispitanika&nbsp; na koncentracije i farmakokinetičke parametare. Ispitivano je prisustvo i stepen kliničkih i laboratorijskih znakova toksičnosti metotreksata, kao i uticaj primenjene&nbsp; doze&nbsp; metotreksata&nbsp; i demografskih karakteristika ispitanika&nbsp; na pojavu i stepen toksičnosti . U okviru retrospektivno - prospektivne&nbsp; studije&nbsp; ukjučeno&nbsp; je&nbsp; četrdeset&nbsp; i dva pedijatrijska&nbsp; pacijenta&nbsp; uzrasta od&nbsp; 0,75 do 17,75 godina (medijana 5,75&nbsp; godina). Svi pacijenti&nbsp; su lečeni&nbsp; u&nbsp; Službi&nbsp; za&nbsp; hematologiju i&nbsp; onkologiju&nbsp; Instituta&nbsp; za&nbsp; zdravstvenu za&scaron;titu dece i omladine Vojvodine (Novi Sad, Srbija) u periodu od juna 2004. godine do juna 2012. godine. Trideset i osam ispitanika&nbsp; je lečeno pod dijagnozom akutne limfoblastne leukemije&nbsp; prema dva&nbsp; uzastopna&nbsp; protokola ALL IC - BFM 2002 i ALL IC - BFM 2009 Internacionalne&nbsp; BFM studijske&nbsp; grupe &bdquo;I - BFM - SG&ldquo;&nbsp; (International Berlin -Frankfurt - M&uuml;nster Study Group) za proučavanje i lečenje dečje non-B akutne limfoblastne leukemije. Četvoro je&nbsp; imalo&nbsp; dijagnozu non - Hodgkin limfoma&nbsp; i bili su uključen i u&nbsp; protokol NHL - BFM&nbsp; 95. Istraživanje je obuhvatilo 113 ciklusa terapije metotreksatom (1&ndash; 4 ciklusa po pacijentu) sa 386 izmerenih serumskih koncentracija metotreksata. Raspon primenjenih doza metotreksata kretao se od 800 do 10.000 mg. Koncentracije metotreksata su merene 24, 36 i 42 sata nakon započinjanja infuzije metotreksata, a po potrebi i u dužim vremenskim intervalima. Za izračunavanje farmakokinetičkih parametara kori&scaron;ćen je dvokompartmanskih farmakokinetički&nbsp; model posle obustavljanja&nbsp; intravenske&nbsp; infuzije,&nbsp; gde&nbsp; postoje relacije&nbsp; za&nbsp; farmakokinetičke&nbsp; tačke. Podaci o kliničkim i laboratorijskim znacima toksičnosti metotreksata prikupljani su iz medicinske dokumentacije, a za stepenovanje toksičnosti kori&scaron;ćen je skor sistem - Common Terminology Criteria for&nbsp; Adverse&nbsp; Events (CTCAE), Version 4.0, U.S. Department&nbsp; of&nbsp; health&nbsp; and&nbsp; human services, National Institute of Health, National Cancer Institute. U cilju utvrđivanju uticaja karakteristika ispitanika, primenjene doze i prisustva produžene eliminacije na posmatrane parametre, vr&scaron;eno je poređenje tri grupe&nbsp; pacijenata (doza 2 g/m² bez produžene eliminacije, 5 g/m² bez produžene liminacije i 5 g/m² sa produženom eliminacijom metotreksata). Za celokupnu grupu ispitanika,&nbsp; medijane&nbsp; koncentracije metotreksta&nbsp; bile&nbsp; su 25,82 &mu;mol/l u 24. satu, 0,68 &mu;mol/l u 36. satu i 0,24 &mu;mol/l u 42. satu merenja. Najizraženija interindividualna varijabilnost u koncentracijama metotreksata bila je u 42. satu merenja, dok je&nbsp; intraindividualna varijabilnost bila najizraženija u 36. satu merenja. Medijana&nbsp; klirensa&nbsp;&nbsp; metotreksata&nbsp;&nbsp; bila&nbsp; je 8,32&nbsp;&nbsp; l/h. Farmakokinetički parametri&nbsp; redom bili su:&nbsp; medijana&nbsp; volumena&nbsp; centralnog&nbsp; kompartmana V₁ 28,47&nbsp; l, medijane konstanti k₁₀ 0,206, k₁₂ 0,0245, k₂₁ 0,1114. Najizraženiji uticaj primenjene doze na koncentracije metotreksata pokazan je u 24.&nbsp; satu&nbsp; merenja, dok uticaj doze na klirens&nbsp; metotreksata nije&nbsp; pokazan. Prisustvo produžene eliminacije metotreksata dovodi do smanjenih vrednosti konstanta k₁₀ i k₂₁. Nije pokazana statistički značajna&nbsp; interakcija ispitivanih demografskih karakteristika (uzrast, telesna povr&scaron;ina i pol)&nbsp; i koncentracija metotreksata, kao ni klirensa metotreksata. Pokazana je značajna interakcija između koncentracija metotreksata i nivoa laktat dehidrogenaze, kao i klirensa metotreksata i nivoa kreatinina i laktat dehidrogenaze. Većina ispoljenih&nbsp; toksičnosti bila je umerenog stepena (&lt;3 stepena). Najzastupljeniji klinički znak toksičnosti bio je oralni mukozitis, koji je bio većeg stepena u grupi sa većom primenjenom dozom metotreksata&nbsp; (5g/m²). Najzastupljeniji&nbsp; laboratorijski toksični efekti&nbsp; metotreksata bili su leukopenija i anemija. Najteži stepeni laboratorijskih znakova toksičnosti (leukopenija, anemija, porast&nbsp; AST,&nbsp; ALT i GGT) nalazili su se u grupi sa većom dozom&nbsp; (5 g/m²) i&nbsp; sa produženom eliminacijom metotreksata. Osnov&nbsp; za&nbsp; kliničko&nbsp; vođenje&nbsp; pacijenata&nbsp; na&nbsp; terapiji visokim dozama metotreksata je terapijsko praćenje leka (therapeutic drug monitoring &ndash; TDM) zbog velikih&nbsp; interindividualnih i intraindividualnih&nbsp; varijabilnosti&nbsp; u&nbsp; farmakokinetici&nbsp; leka. Rutinsko praćenje koncentracija metotreksata važno je za identifikaciju pacijenata sa povećanim rizikom od razvoja toksičnosti ,&nbsp; te&nbsp; je TDM&nbsp; standardna&nbsp; praksa&nbsp; za smernice spasavanja leukovorinom, naročito za pacijente za koje se zna da imaju smanjen&nbsp;&nbsp; klirens metotreksata ili druge rizike povezane sa prolongiranim citotoksičnim koncentracijama (bubrežna ili jetrena o&scaron;tećenja, kolekcije tečnosti u &ldquo;trećem prostoru&rdquo;, gastrointestinalna opstrukcija). Veliki&nbsp; broj&nbsp; istraživanja&nbsp; kod pedijatrijskih pacijenata pokazao je vezu između sistemskog izlaganja metotreksatu i&nbsp; efikasnosti&nbsp; i&nbsp; toksiĉnosti&nbsp; metotreksata. Ipak, ne postoji dovoljno&nbsp; informacija o farmakokinetici metotreksata kod dece obolele od akutne limfoblastne leukemije. Takođe, ova istraživanja nisu do sada sprovođena kod dece koja su lečena u na&scaron;oj sredini.</p> / <p>Methotrexate&nbsp; is&nbsp; an&nbsp; antifolate&nbsp; drug&nbsp; widely&nbsp; used&nbsp; for&nbsp; treatment&nbsp; of&nbsp; various malignant&nbsp; tumours.&nbsp; It&nbsp; is&nbsp; used&nbsp; at&nbsp; high&nbsp; doses&nbsp; and&nbsp; in&nbsp; combination&nbsp; with leucovorin rescue.&nbsp; Although&nbsp; high - dose&nbsp; MTX&nbsp; therapy&nbsp; dramatically&nbsp; improves&nbsp; the&nbsp; prognosis&nbsp; of patients with malignancies, severe adverse events are constant clinical concern. The&nbsp; aims&nbsp; of&nbsp; this&nbsp; stydy&nbsp; were&nbsp; to&nbsp; determine&nbsp; the&nbsp; serum&nbsp; concentration&nbsp; of&nbsp; methotrexate&nbsp; and&nbsp; to&nbsp; calculate&nbsp; the&nbsp; pharmacokinetic&nbsp; parameters&nbsp; of&nbsp; methotrexate&nbsp; in children&nbsp; suffering&nbsp; from&nbsp; malignant&nbsp; deseases&nbsp; who&nbsp; are&nbsp; treated&nbsp; with&nbsp; high&nbsp; doses&nbsp; of metotrexate&nbsp; (2&nbsp; g/m² i&nbsp; 5&nbsp; g/m² );&nbsp; furthermore,&nbsp; to&nbsp; investigate&nbsp; the&nbsp; effects&nbsp; of&nbsp; the&nbsp; applied doses of methotrexate, and demographic and clinical characteristics of the examinees on&nbsp;&nbsp; the&nbsp;&nbsp; concentration&nbsp;&nbsp; and&nbsp;&nbsp; pharmacokinetic&nbsp;&nbsp; parameters&nbsp;&nbsp; of&nbsp;&nbsp; the&nbsp;&nbsp; drug.&nbsp;&nbsp; The&nbsp;&nbsp; study investigated the&nbsp;&nbsp; presence&nbsp;&nbsp; and&nbsp;&nbsp; the&nbsp;&nbsp; degree&nbsp;&nbsp; of&nbsp;&nbsp; clinical&nbsp;&nbsp; and&nbsp;&nbsp; laboratory&nbsp;&nbsp; signs&nbsp;&nbsp; of metotrexate&nbsp; toxicity,&nbsp; as&nbsp; well&nbsp; as&nbsp; the&nbsp; effect&nbsp; of&nbsp; the&nbsp; applied&nbsp; doses,&nbsp; and&nbsp; demographic characteristics of the examinees on the appearance and the degree of toxicity. The retrospective - prospective study included 42&nbsp; pediatric patients aged from 0.75&nbsp; to&nbsp; 17.75&nbsp; years&nbsp; (median&nbsp; 5.75&nbsp; years).&nbsp; All&nbsp; patients&nbsp; were&nbsp; threated&nbsp; at&nbsp; the&nbsp; Children and Youth Health Care Institute of Vojvodina (Novi Sad, Serbia), Hemathology and Oncology&nbsp; Section,&nbsp; in&nbsp; the&nbsp; period&nbsp; from&nbsp; June&nbsp; 20 04&nbsp; to&nbsp; June&nbsp; 2012.&nbsp; 38&nbsp; examinees diagnosed as acute lymphoblastic leukemia were treated according to two subsequent protocols,&nbsp; ALL&nbsp; IC - BFM&nbsp; 2002&nbsp; and&nbsp; ALL&nbsp; IC - BFM&nbsp; 2009&nbsp; of&nbsp; the&nbsp; International&nbsp; BFM study&nbsp; group &bdquo;I - BFM - SG&ldquo; (International Berlin - Frankfurt - M&uuml;nster&nbsp; Study&nbsp; Group)&nbsp; for management&nbsp;&nbsp; of&nbsp;&nbsp; childhood&nbsp;&nbsp; non - B&nbsp;&nbsp; acute&nbsp;&nbsp; lymphoblastic&nbsp;&nbsp; leukemia.&nbsp;&nbsp; 4&nbsp;&nbsp; examinees diagnosed&nbsp; as&nbsp; non - Hodgkin&nbsp; lymphoma&nbsp; were&nbsp; treated&nbsp; according&nbsp; to&nbsp; the&nbsp; NHL - BFM&nbsp; 95 protocol. The study included 113 cycles of therapy with methotrexate (1-4 cycles per patient)&nbsp; with&nbsp; 3 86&nbsp; measured&nbsp; serum&nbsp; concentrations&nbsp; of&nbsp; methotrexate.&nbsp; The&nbsp; range&nbsp; of&nbsp; the applied doses was between 800 and 10,000 mg. The&nbsp; concentration&nbsp; of&nbsp; methotrexate&nbsp; was&nbsp; measured&nbsp; 24,&nbsp; 36&nbsp; and&nbsp; 42&nbsp; hours&nbsp; after the initiation of the methotrexate infusion, as well as in longer time intervals when needed.&nbsp; To&nbsp; calculate&nbsp; the&nbsp; pharmacokinetic&nbsp; parameters,&nbsp; the&nbsp; study&nbsp; applied&nbsp; the&nbsp; two - compartment&nbsp; pharmacokinetic&nbsp; model&nbsp; after&nbsp; the&nbsp; termination&nbsp; of&nbsp; intravenous&nbsp; infusion, when&nbsp; relations&nbsp; for&nbsp; pharmacokinetic&nbsp; points&nbsp; existed.&nbsp; Data&nbsp; on&nbsp; clinical&nbsp; and&nbsp; laboratory signs of methotrexate toxicity were collected&nbsp; from medical documentation, and the Common&nbsp; Terminology&nbsp; Criteria&nbsp; for&nbsp; Adverse&nbsp; Events&nbsp; (CTCAE),&nbsp; Version&nbsp; 4.0,&nbsp; U.S. Department&nbsp; of&nbsp; health&nbsp; and&nbsp; human&nbsp; services,&nbsp; National&nbsp; Institute&nbsp; of&nbsp; Health,&nbsp; National Cancer&nbsp; Institute, was&nbsp; used&nbsp; as&nbsp; the&nbsp; score&nbsp; system&nbsp; for&nbsp; toxicity&nbsp; ranking.&nbsp; In&nbsp; order&nbsp; to determine&nbsp; the&nbsp; effects&nbsp; of&nbsp; the examinees&rsquo;&nbsp; characteristics, applied&nbsp; doses&nbsp; and&nbsp; the presence&nbsp; of&nbsp; prolonged&nbsp; elimination on&nbsp; the&nbsp; parameters&nbsp; of&nbsp; interest,&nbsp; three&nbsp; groups&nbsp; of patients were&nbsp; compared (2 g/m² dose without prolonged elimination, 5 g/m² without prolonged elimination and 5 g/m² with prolonged elimination of methotrexate). In the&nbsp; entire&nbsp; group of&nbsp; examinees, the median&nbsp; concentration of methotrexate was&nbsp; 25.82 &mu;mol/l in the 24th hour, 0.68 &mu;mol/l in the 36th&nbsp; hour&nbsp; and 0.24 &mu;mol/l in the 42nd hour of&nbsp; observation. The largest inter - individual variability of methotrexate concentration&nbsp; was&nbsp; observed&nbsp; in&nbsp; the&nbsp; 24th&nbsp; hour&nbsp; while&nbsp; the&nbsp; largest&nbsp; intra - individual variability&nbsp; was&nbsp; recorded&nbsp; in&nbsp; the&nbsp; 36th&nbsp; hour&nbsp; of&nbsp; observation.&nbsp; The&nbsp; median&nbsp; clearance&nbsp; of methotrexate&nbsp; was&nbsp; 8.32l/h.&nbsp; Pharmacokinetic&nbsp; parameters&nbsp; were&nbsp; the&nbsp; following:&nbsp; median volume&nbsp; of&nbsp; the&nbsp; central&nbsp; compartment V₁ 28.47&nbsp; l,&nbsp; median&nbsp; constants k₁₀ 0,206, k₁₂ 0,0245, k₂₁ 0,1114, respectively. The&nbsp;&nbsp; strongest&nbsp;&nbsp; influence&nbsp;&nbsp; of&nbsp;&nbsp; the&nbsp;&nbsp; applied&nbsp;&nbsp; dose&nbsp;&nbsp; on&nbsp;&nbsp; the&nbsp;&nbsp; methotrexate concentration was recorded in the 24th hour of observation while no influence on the methotrexate&nbsp; clearance&nbsp; was&nbsp; found.&nbsp; The&nbsp; presence&nbsp; of&nbsp; prolonged&nbsp; elimination&nbsp; of methotrexate&nbsp;&nbsp; causes&nbsp;&nbsp; lower&nbsp; constants k₁₀ and&nbsp;&nbsp; k₂₁. There&nbsp;&nbsp; was&nbsp;&nbsp; no&nbsp;&nbsp; statistically significant&nbsp; interaction&nbsp; between&nbsp; the&nbsp; investigated&nbsp; demographic&nbsp; characteristics&nbsp; (age, body&nbsp; surface&nbsp; and&nbsp; gender)&nbsp; and&nbsp; the&nbsp; methotrexate&nbsp; concentration,&nbsp; nor&nbsp; between&nbsp; the demographic&nbsp;&nbsp; characteristics&nbsp;&nbsp; and&nbsp;&nbsp; the&nbsp;&nbsp; methotrexate&nbsp;&nbsp; clearance.&nbsp;&nbsp; A&nbsp;&nbsp; significant interaction was found between methotrexate concentration and lactat dehydrogenase level, as&nbsp;&nbsp; well&nbsp;&nbsp; as&nbsp;&nbsp; between&nbsp;&nbsp; methotrexate&nbsp;&nbsp; clearance&nbsp;&nbsp; and&nbsp;&nbsp; creatinine&nbsp;&nbsp; and&nbsp;&nbsp; lactate dehydrogenase level, respectively. Most of the observed toxicities were of moderate degree (&lt; 3 degrees). Oral mucositis&nbsp; was&nbsp; the&nbsp; most&nbsp; represented&nbsp; clinical&nbsp; sign&nbsp; of&nbsp; toxicity,&nbsp; and&nbsp; it&nbsp; was&nbsp; of&nbsp; higher degree&nbsp; in&nbsp; the&nbsp; group&nbsp; where&nbsp; the&nbsp; applied&nbsp; dose&nbsp; of&nbsp; methotrexate&nbsp; was&nbsp; higher&nbsp; (5&nbsp; g/m² ). Leucopenia&nbsp; and&nbsp; anemia&nbsp; were&nbsp; the&nbsp; most&nbsp; represented&nbsp; laboratory&nbsp; toxic&nbsp; effects.&nbsp; The most severe laboratory signs of toxicity&nbsp; (leucopenia, anemia, increase in AST, ALT and&nbsp; GGT&nbsp; activity)&nbsp; were&nbsp; observed&nbsp; in&nbsp; the&nbsp; group&nbsp; with&nbsp; the&nbsp; higher&nbsp; dose&nbsp; (5&nbsp; g/m² )&nbsp; and prolonged methotrexate elimination. Due to high inter- and&nbsp;&nbsp; intra-individual&nbsp;&nbsp;&nbsp; variability&nbsp; of&nbsp; the drug pharmacokinetics,&nbsp; the&nbsp; basis&nbsp; for&nbsp; the&nbsp; clinical&nbsp; care&nbsp; of&nbsp; patients&nbsp; on&nbsp; high&nbsp; methotrexate dosage&nbsp; therapy&nbsp; is&nbsp; therapeutic&nbsp; drug&nbsp; monitoring &ndash; TDM.&nbsp; Routine&nbsp; monitoring&nbsp; of methotrexate serum concentration is important for the identification of patients with a high&nbsp; risk&nbsp; of&nbsp; toxicity,&nbsp; and&nbsp; thus&nbsp; TDM&nbsp; is&nbsp; used&nbsp; as&nbsp; a&nbsp; standard&nbsp; procedure&nbsp; which&nbsp; provides guidelines&nbsp; for&nbsp; leucovorin&nbsp; rescue,&nbsp; particularly&nbsp; for&nbsp; patients&nbsp; with&nbsp; a&nbsp; lower&nbsp; methotrexate clearance or other risks associated with prolonged cytotoxic concent rations (kidney or liver&nbsp; damage,&nbsp; body&nbsp; fluid&nbsp; accumulation&nbsp; in&nbsp; the&nbsp; &ldquo;third&nbsp; space&rdquo;,&nbsp; gastrointestinal obstruction). Numerous studies involving pediatric patients have documented the link between&nbsp; a&nbsp; systemic&nbsp; methotrexate&nbsp; exposure&nbsp; on&nbsp; one&nbsp; hand,&nbsp; and&nbsp; the&nbsp; efficiency&nbsp; and toxicity of&nbsp; ethotrexate on the other hand. However, there is no sufficient data on the methotrexate&nbsp;&nbsp;&nbsp; pharmacokinetics&nbsp;&nbsp; in&nbsp;&nbsp; children&nbsp;&nbsp; suffering&nbsp;&nbsp; from&nbsp;&nbsp; acute&nbsp;&nbsp; lymphoblastic leukemia.&nbsp;&nbsp; Moreover,&nbsp;&nbsp; this&nbsp;&nbsp; type&nbsp;&nbsp; of&nbsp;&nbsp; research,&nbsp;&nbsp; involving&nbsp;&nbsp; children&nbsp;&nbsp; treated&nbsp;&nbsp; in&nbsp;&nbsp; the geographical region of this study, have not been conducted.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Opioid misuse and addiction has been widely identified as a public health problem, contributing substantially to the nation’s morbidity and mortality. Over the past two decades, misuse of prescription opioids pain relievers has substantially increased; heroin use has resurged; and, more recently, abuse of high-potency synthetic opioids such as fentanyl have fueled the epidemic. Nearly 12 million Americans (or 4.4%) aged 12 and older misused some type of opioid (prescribed or illegal) in the past year. Furthermore, the percentage of substance use treatment admissions attributable to opioids nearly doubled in the U.S., from 20.8% in 2000 to 40.5% in 2015. The purpose of this dissertation research was to investigate associations between prescription pain reliever use and subsequent negative health outcomes, including opioid misuse or addiction, and neonatal abstinence syndrome. This research focused on three specific aims: Specific Aim #1: Examine heroin use among Indiana’s substance use treatment population to measure the extent, trends, and patterns of use, as well as to assess the relationship between prescription opioids and subsequent heroin use; Specific Aim #2: Analyze 2014 INSPECT (Indiana’s prescription drug monitoring program) data to identify factors that increase patients’ likelihood to engage in opioidrelated risk behaviors; and Specific Aim #3: Review U.S. trends in neonatal abstinence syndrome (NAS) incidence from 2008-2014, measure regional variability, and identify personal and environmental risk factors associated with NAS. / 2020-08-09

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Affinity molecules can serve as precision tools for selective recognition and measurement of specific biomolecules in the fields of therapeutic drug monitoring and quality control in recombinant protein production. In therapeutic drug monitoring, affinity molecules can enable the accurate quantification of drug concentrations within physiological fluids, enhancing both the safety and efficacy of clinical treatments. In the realm of recombinant protein production, these molecules can allow precise isolation and measurement of desired recombinant proteins from complex mixtures by selectively targeting specific protein tags or domains, ensuring the consistency and purity of protein products. Currently, antibodies are most commonly used affinity reagents in these fields but are limited by production complexity, batch variability, high cost, and low stability. Aptamers, known as ‘chemical antibodies’ but composed of nucleotides, are considered potential next-generation affinity reagents. Aptamers are obtained via a synthetic process, termed SELEX, of iterative affinity selection and polymerase chain reaction (PCR) amplification of target-binding members from a randomized oligonucleotide library. This process is traditionally labor and resource-intensive and time-consuming. In this thesis, microfluidic technology is employed to enable time-efficient and cost-effective generation of aptamers for monoclonal antibodies and recombinant proteins toward applications in therapeutic drug monitoring and quality control of recombinant protein production. This thesis starts with a comparative study of three SELEX strategies for aptamer isolation, including those using conventional agarose bead-based partitioning, microfluidic affinity selection (called “chip-selection SELEX”), and fully integrated microfluidic affinity selection and PCR amplification (termed “full-chip SELEX”). The comparison results indicate that chip-selection SELEX offers the lowest cost and highest efficiency in aptamer isolation. We then use chip-selection SELEX to streamline the process of isolating anti-idiotype aptamers targeting human monoclonal antibodies against spike protein of SARS-CoV-2 virus. The process is completed within only 5 rounds of SELEX within two days, which represented a significant improvement when compared to conventional methods whose completion generally requires more than 10 SELEX rounds in up to a month. These anti-idiotype aptamers are combined with a graphene-based affinity nanosensor to enable rapid antibody concentration measurements to inform therapeutic decisions in a timely manner. In addition, a microfluidic dual-aptamer sandwich assay with highly efficient isolation of aptamers is developed to enable rapid and cost-effective detection of tag-fused recombinant proteins. This approach addresses both the limitations of current dual-aptamer assays and commonly encountered difficulties in the lack of aptamers available for such assays, by first using chip-selection SELEX to generate aptamers and then employing these aptamers to implement a microfluidic dual-aptamer assay for quality control during recombinant protein production. Despite the high efficiency in aptamer isolation using chip-selection SELEX, the full-chip SELEX platform is still desired for minimal manual operation and reagent consumption. The current full-chip SELEX platform has low isolation efficiency and could not offer information of affinity selection process. Herein, by introducing asymmetric PCR into the full-chip SELEX process, we improve the efficiency in aptamer isolation and can successfully monitor the selection progress. This real-time monitoring capability allows us to identify the optimal point to terminate the SELEX process, preventing the potential loss of aptamer candidates and reducing the overall consumption of time and reagents. In addition, introducing solution phase-based asymmetric PCR addresses a notable technical challenge of on-chip PCR bead replenishment, toward complete automation of the full-chip SELEX platform. Furthermore, a holder equipped with connection pins is designed to enable the reversible connection between gold electrodes and electrical wires. This design promotes the reusability of gold electrode-deposited glass substrates, resulting in a substantial reduction in chip fabrication costs. In addition to the SELEX protocol development effort, we also present efficient and cost-effective microfluidic approaches for post-SELEX aptamer characterization, including aptamer identification and kinetic aptamer-target binding measurements. To mitigate the expensive and time-consuming nature of aptamer identification from SELEX-generated target-binding sequence pools, we present an approach that is based on a cost-effective and efficient procedure to generate modified single-stranded DNA copies of the aptamer candidates and then assess the affinity of the resulting modified ssDNA strands to target molecules. The approach is applied to identify aptamers from 12 candidates with consistent results, but at a cost three times lower than that of established methods. We also present a microfluidic fluorescence assay, which exploits a synergistic combination of microfluidic technology and fluorescence microscopy, to realize cost-effective and multiplexed measurement of kinetics of aptamer-target analyte binding without requiring special-purpose equipment.

The antiseizure medication levetiracetam is used to treat epilepsy with significant success, the medication concentration in serum may be affected by other co-administered medication. Levetiracetam is excreted renally, and the halftime is depending on the renal function which is often correlated to age. The clinical chemistry laboratory at Sundsvall hospital did previously send samples for levetiracetam analysis to Karolinska University Hospital in Stockholm. There was a wish to start analysing the medication locally to reduce analysis time and thereby increase patient safety. ARK Diagnostic markets a kit for quantitative analysis of levetiracetam on automated chemistry analysers. The sample may be taken in a few different test tubes with slightly different characteristics. The aim of this study was to verify the ARK kit on Cobas Pro c503 at Sundsvall hospital and investigate the effects of different test tubes. To assess the accuracy and precision of the method, serum was spiked with levetiracetam from a liquid solution to construct dilution series for testing linearity and sample materials, and by running internal controls to assess the repeatability and reproducibility of the method. The results show that the method does in fact give accurate measurements of the levetiracetam concentration and the results does not vary more than acceptable between measurements nor over time and that different sample type does not show a clinically important difference in result.