Abstract available thorugh the American Journal of Pharmaceutical Education.

Abstract available in the American Journal of Pharmacy Education.

Abstract is available in the American Journal of Pharmaceutical Education.

Purpose:Omeprazole is a proton pump inhibitor (PPI) used in the treatment of gastrointestinal conditions, such as gastrointestinal esophageal reflux disease (GERD). Omeprazole is often prepared as an oral suspension to accommodate certain patients. Historically, oral suspensions of omeprazole were prepared using pharmaceutical compounding with sodium bicarbonate, but a kit for preparation of omeprazole oral suspension is available, FIRST® - Omeprazole. The purpose of this project is to compare the stability of the active pharmaceutical ingredient (API), omeprazole, in the FIRST® kit product to a traditionally compounded omeprazole suspension, when stored in refrigerated unit-dosed syringes. Methods: Five 100-mL batches of compounded omeprazole oral suspension (2 mg/mL) and five 300-mL kits of FIRST® - Omeprazole were prepared by a licensed pharmacist, and aliquoted into 5-mL doses in clear luer-lock plastic oral syringes, and stored at refrigerated temperature (2-8oC). Omeprazole concentration was assessed in each batch/kit on the day of preparation. Triplicate syringes from each batch/kit (n = 15 per test group per day) were removed after 7 days, 14 days, 21 days, and 30 days of refrigerated storage. Samples were diluted to assay concentration (1 mg/mL) in ion-free water and filtered using a 0.22-micron microcentrifuge filter tube. Samples were analyzed for omeprazole recovery using a validated high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method. Recovery was quantitatively assessed by comparing sample peak area to a freshly prepared calibration curve (1 – 0.125 mg/mL) using United States Pharmacopoeia (USP) reference standard on each day of sampling. Refrigerator temperatures were recorded daily using a digital thermometer. Results:Stability was defined as recovery of 90 - 110% of initial concentration of API. For the FIRST® - Omeprazole samples, the chemical potency remained within this window for the entire study period of 30 days. The compounded omeprazole suspension demonstrated a less than 90% average recovery at the day 21 sample. Furthermore, a statistically significant difference in the initial concentration was detected on the day of compounding (p = 0.0244), with the compounded omeprazole starting at 1.89 ± 0.10 mg/mL and the FIRST® - Omeprazole at 1.98 ± 0.04 mg/mL. After 30 days, the compounded omeprazole suspension had an 89.13% average API recovery (standard deviation; ± 5.17%) and the FIRST® - Omeprazole 97.20% API recovery (± 3.59%). Conclusion:Both traditionally compounded omeprazole suspension (2mg/mL) and FIRST® - Omeprazole suspension (2mg/mL) may be stored in clear luer-lock oral syringes under refrigeration for 14 days, and retain potency between 90 to 110% based on initial concentration. Furthermore, the FIRST® - Omeprazole suspension can be stored for the duration of the product’s beyond-use date of 30 days and retain potency between 90 to 110% of initial concentration or label claim. Finally, the data suggest that API concentration in FIRST® - Omeprazole suspension is more consistent from batch to batch than traditionally compounded omeprazole suspension.

Objectives: To assess labelling accuracy for low nicotine concentration e‐cigarette liquids. Methods: Nicotine concentration in twelve e‐liquids, available in 3 and 6 mg/ml strengths, was assayed (5 replicates each) using liquid chromatography–tandem mass spectrometry. Key findings: Average nominal concentrations of nicotine were lower than reported in 23/24 products tested, with 2/12 products labelled 3 mg/ml, and 3/12 of the 6 mg/ml products showing statistically significant differences from controls. Conclusions: Despite the emergence of a global regulatory environment for e‐cigarettes, inaccuracies still exist in nicotine concentration labelling, which may affect user habits and reliability of products used in smoking cessation.

Background: Most over-the-counter medications are labeled for storage in a dry, room temperature environment. Despite this, many households store medications in the bathroom, where temperature and humidity extremes may be experienced.Objective:In this project, we sought to investigate the effect that long-term storage in a household bathroom had on potency of over-the-counter ibuprofen (IBU) products as well as on the emergence of a known toxic degradation product, 4-isobutylacetophenone (4-IBP). Methods:A liquid chromatography-tandem mass spectrometry method was developed for the quantitative determination of IBU and 4-IBP in aqueous samples. Three brands each of IBU tablets (200 mg) and suspensions (100 mg/5 mL) were assayed for IBU concentration at the initiation of the study and once monthly thereafter. The samples were stored in a household bathroom, with continuous temperature and humidity monitoring. Each sample was assayed in triplicate and percent recovery was calculated against freshly prepared standards of IBU using bulk powder.Results:Tablets maintained >90% average strength through 3 months, with statistically significant deviation from initial concentration (2-way analysis of variance, P = .05) detected after 6 to 7 months. Suspensions maintained >90% average strength through 5 months, with statistically significant changes from initial concentration emerging after 7 months. After 12 months, the average strength was 73% and 83% for tablets and suspensions, respectively. 4-IBP was not detected in any of the samples during the duration of the study.Conclusions:These data indicate that, while 4-IBP was not detected following 12-month bathroom storage of commercial IBU products, significant changes in potency should negatively affect efficacy.

Purpose: Inflammation is characterized by complex interactions between pro- and anti- inflammatory cytokines. Recent research has probed the role of the nervous system in inflammation, part of which includes the cholinergic anti-inflammatory pathway that regulates immunologically-mediated inflammation. In this pathway, norepinephrine release from the splenic nerves binds to beta-2-adrenergic receptors on T cells, causing release of acetylcholine (ACh). ACh subsequently suppresses macrophage production and release of pro-inflammatory cytokines. The purpose of this project is to quantify ACh release from isolated murine splenocytes when challenged with different mediators that stimulate T cells in this pathway. Methods:Our method utilizes liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) for quantification of ACh and choline (Ch) in cell culture media. The developed LC-MS/MS method utilizes an isocratic separation (14% 10mM ammonium formate, pH 3, and 86% acetonitrile) on an Atlantis HILIC column (2.1 x 100 mm, 3 micron). The MS operates in positive electrospray (+ESI) mode, monitoring ions specific for ACh, Ch, and their corresponding deuterium labeled internal standards. The calibration range for ACh was 0.01 - 5 micrograms/ml (0.068 - 34 mM) and 10 - 50 micrograms/ml (96 - 480 mM) for Ch. Cell culture media contained neostigmine (0.5 mM) to inhibit cholinesterase. Cell culture media samples are prepared by freeze drying, reconstituting in acetonitrile, and filtering (0.2micron). Potential loss of ACh through degradation during cell culture was evaluated by monitoring d4-labeled ACh with and without the presence of splenocytes for 4 and 24 hours. Splenocytes were challenged with saline (control) or 1 mM (-) isoproterenol for 4 and 24 hours in the next set of experiments, and ACh in the medium was quantified. We also evaluated separate and combined effects of isoproterenol and activation of T cells with CD3 and CD28 antibodies on ACh release. Results:Correlation coefficients (R2) indicate linearity for ACh and Ch in culture media in the calibration range. During the six-min separation, ACh elutes at 3.8 min and Ch at 5.1 min. Deuterium-labeled ACh, when incubated in cell culture media for 4 and 24 hours, with and without splenocytes, showed a small but statistically significant loss of ACh after 24 h compared to 0 time media controls. However, the average loss of ACh was less than 10% and was not affected by the presence of splenocytes, suggesting that it was due to chemical hydrolysis. Incubation for 4 hr with and without splenocytes did not affect recovery of ACh. Treatment of splenocytes with isoproterenol for 4 hours did not cause significant release of ACh. However, significant release of ACh was detected after 24 hours exposure to isoproterenol or T cell activation. Media from untreated splenocytes had an ACh concentration of 0.14 +/- 0.07 mcg/mL. Isoproterenol treated had 0.28 +/- 0.14 mcg/mL, T-cell activated had 0.32 +/- 0.17 mg/mL, and isoproterenol + T-cell activation had 0.47 +/- 0.16 mcg/mL. Using a 1-way analysis of variance, statistically significant differences were detected between each of these groups. Conclusion: The developed LC-MS/MS assay for quantification of ACh and Ch in cell culture media can be applied to the investigation of the cholinergic anti-inflammatory pathway in isolated splenocytes. Statistically significant differences in ACh release between control splenocytes and those treated with isoproterenol and T-cell activation can be detected. Quantitative investigation of this pathway helps provide an improved understanding of ACh dynamics as a mediator released from leukocytes. Further studies using this model and methodology will provide novel insights into cholinergic anti-inflammatory mechanisms and other immunomodulatory actions of non-neuronal ACh.

This project describes the development of a new antitumor therapeutic platform that combines the benefits of small-molecule drug conjugates (SMDCs) and antibody drug conjugates (ADCs). Valine-citrulline (VCit) dipeptide linkers are popular cathepsin B cleavable ADC linkers. Due to its instability in mouse serum, translating efficacy data from mouse to human is more difficult. It has been reported that replacing the VCit linker with glutamic acid-valine-citrulline (EVCit) improves ADC stability in mouse serum. The effect of the EVCit linker on the stability of SMDCs has not been reported so far. In a xenograft mouse model of prostate cancer, we found that incorporating the EVCit linker in PSMA-targeting SMDCs equipped with the transthyretin ligand AG10 resulted in conjugates with lower toxicity, extended half-life, and superior therapeutic efficacy compared to the standard metastatic castration-resistant prostate cancer (mCRPC) treatment option, docetaxel. This should improve the predictability of SMDC preclinical toxicity and efficacy data from mice.

Background: Hepatitis C virus is currently the most common chronic blood borne pathogen in the United States, with only half of those infected aware of their condition. The cost for treatment is higher with Harvoni® (ledipasvir/sofosbuvir) than Viekira Pak® (ombitasvir/paritaprevir/ritonavir and dasabuvir). With finite resources available to treat patients, it is important to understand which clinical factors may influence treatment selection decisions. Methods: The study is a 12-month medical record review within the Veterans Affairs (VA) system to evaluate significant relationships between selected clinical and sociodemographic factors and HCV treatment selection with either Harvoni® or Viekira Pak®. Clinical and demographic information was collected as well a presence of interacting medications, contraindication to components of the treatment regimen, and the treatment regimen indicated and selected. Results: In total, 25,717 patients were extracted from the database and were compared by the use of frequency charts and logistic regression analysis with results reflective of the nationally reported numbers. There was a statistically significant difference in the prescribing pattern between the VA Northern California Health System (station 612) and the other stations nationally with Viekira Pak® prescribed more often in that station. Station 612 utilized an electronic decision tree (otherwise known as a ‘quick order’) during the medication ordering process. In a comparison between station 612 and the other stations within the VA a notable difference in the impact of drug-drug interactions on the prescribing patterns was found within station 612. Conclusion: Many methods can be used to ensure optimal treatment for HCV infections. In station 612 the use of a decision tree may have assisted in avoidance of potentially modifiable factors which enabled for a higher utilization of the less expensive treatment option, Viekira Pak®, for HCV infections, thereby potentially allowing for more Veterans to be treated with finite resources.

Solid tumors possess biological features that are different from those in healthy tissues, which provides opportunities of anticancer treatment by nanomedicines. Due to the presence of the fenestrated tumor vasculatures, nanomedicines can selectively accumulate in tumor tissues by the enhanced permeability and retention (EPR) effect. The acidic pH in tumor interstitium (pH 6.0-7.0) also provides a promising mechanism to trigger the nanomedicines to promote the cellular uptake of cargo drugs. The previously reported stealth liposomes coated with PEG are known to accumulate in tumors owing to their prolonged circulation time. The PEG coating on liposomes can hinder serum protein adsorption and thus prevent rapid elimination by the reticuloendothelial system, thus increasing the liposome circulation time. However, liposomal interaction with cancer cells can also be hindered by the PEG coating. In order to improve the anticancer activity of stealth liposomes, novel synthetic imidazole-based lipids were introduced to the composition of stealth liposomes to develop the pH-sensitive imidazole-based convertible liposomes (ICL). At acidic pH, the imidazole-based lipids would protonate to acquire positive charges, thus clustering with the negatively charged PEGylated lipids. Such lipid-lipid electrostatic interaction would induce phase separation of the bilayer to generate a PEG-free domain that displays excess positive charges. Such newly converted, cationic liposomes at acidic pH in tumor interstitium would have better interaction with negatively charged cancer cells and/or enhanced drug release, therefore overcoming the drawback of traditional stealth liposomes. After synthesizing the imidazole-based lipids DHI, DHMI and DHDMI, we constructed doxorubicin (DOX)-loaded ICL formulations. The physicochemical properties of ICL were characterized, and factors influencing such properties were explored. The pH-triggered acquisition of positive charges of ICL was confirmed by the elevation of ζ- potentials and aggregation with negatively charged model liposomes that mimic bio-membranes at acidic pH 6.0-7.0. Acidic pH-triggered release of ICL was confirmed by drug release assays. It was also found that although the incorporation of cholesterol can remarkably reduce the size and increase the encapsulation efficiency (EE) of ICL, it also hinders the pH-sensitivity of ICL. The morphology of ICL at both pH 7.4 and pH 6.0 was characterized under transmission electron microscopy (TEM), which showed morphological changes in response to acidic pH 6.0, which further supported the proposed pH-sensitivity of ICL. Cytotoxicity assays on 3D MCS of HeLa, A549, MDA-MB-231 and MDA-MB-468 cell lines were conducted to evaluate the anticancer activity of ICL formulations. ICL formulations without cholesterol showed considerably enhanced anticancer activities against MCS compared with the non-sensitive stealth liposomes (NSL). However, incorporation of cholesterol decreased such activities. The IC50 values of cholesterol-free ICL and ICL with cholesterol against MCS strongly suggested that the pH-sensitivity introduced by the imidazole-based lipids would enhance the anticancer activity of stealth liposomes, while the hindrance of the pH-sensitivity by cholesterol would reduce such activities. Taken together, ICL’s pH-sensitivity is correlated with their enhanced anticancer activity than non-sensitive stealth liposomes.