MUDr. Olga Matoušková - the dissertation theses The influence of individual genetic predisposition to the pharmacokinetics and pharmacodynamics of chosen opioids ABSTRACT Introduction: The aim of this thesis is to study the influence of polymorphism of CYP2D6 and MDR1 on the pharmacokinetics and pharmacodynamics of tramadol in healthy volunteers using measurement. A secondary objective is to evaluate these polymorphisms in relation to the analgesic efficacy and side effects of piritramide for acute postoperative pain. Materials and methods: In two prospective work studying the influence of genetic predisposition on the pharmacokinetic and pharmacodynamic parameters of tramadol, we included a total of 90 healthy volunteers. Clinical studies on opioid analgesia and influence of genetic predisposition to the pharmaco-therapeutic effects and side effects in patients with acute postoperative pain, we included a total of 161 patients with acute postoperative pain. Polymorphism genotyping CYP2D6 and MDR1 gene we performed PCR - RFLP analysis, to determine concentrations of tramadol and metabolite, we used gas and liquid chromatography and pharmacodynamic effects of opioids was evaluated by pupilometric measurement and visual analogue scale. Results and conclusion: Variability of the opioid effect is influenced by...

Estima-se atualmente que mais de 5% da população mundial vem fazendo uso recreativo de algum tipo de substância psicoativa, sendo que o direito a esse uso é tema recorrente da sociedade contemporânea. Por apresentar riscos associados à saúde e a segurança das populações, o uso abusivo dessas substâncias tem instigado a toxicologia social na busca de respostas, com as quais se possa caracterizar, analisar e gerenciar esses riscos. Drogas de grande consumo no Brasil são a anfetamina, cocaína e Cannabis sativa. Esta tese desenvolveu uma nova metodologia para detectar e quantificar anfetamina, cocaína e tetrahidrocanabinol em sangue total, com uso de microextração em fase líquida via fibra de polipropileno (HF-LPME), seguida de cromatografia gasosa acoplada a espectrometria de massa (GC-MS). Trata-se de uma técnica que apresenta vantagens sobre as tradicionais, uma vez que demanda quantidades menores de solvente orgânico, diminuindo riscos e custos de processo. Também propôs um estudo com a aplicação dos métodos em 69 amostras de sangue de vivos e de post mortem, as quais foram obtidas por convênio com a superintendência da polícia técnica científica de São Paulo (SPTC/SP). Os métodos desenvolvidos foram validados de acordo com diretrizes internacionais de interesse forense. Como resultado da validação, os métodos desenvolvidos se mostraram precisos e exatos para anfetamina e cocaína. O limite de detecção da cocaína foi de 5 ng . mL-1 e o limite de quantificação de 10 ng . mL-1. Quanto a anfetamina, os limites de detecção e de quantificação foram de 5 ng . mL-1. A técnica de HF-LPME não foi aplicável ao tetraidrocanabinol (Δ9-THC). Como resultado da análise das amostras, 40% delas apresentaram resultados positivos para cocaína. Desses positivos, 35% foram oriundos das matrizes de sangue de vivos e 64% oriundos de sangue post mortem. Nenhuma delas apresentou resultado quantificável para anfetamina. / It is currently estimated that more than 5% of the world\'s population has been doing recreational use of some kind of psychoactive substances and the legal right to such use is a recurring theme debated by contemporary society. Due to the risks associated with populations health and safety, the abusive use of these substances has been instigating by social toxicology to search for answers to characterize, analyze and manage these risks. Drugs of great consumption in Brazil are, amphetamine cocaine and marijuana. This thesis proposes to develop a new methodology to detect and quantify psychoactive drugs in whole blood with the use of liquid phase microextraction by polypropylene fiber (HFLPME), followed by gas chromatography coupled to mass spectrometry (GC-MS). It is a technique that presents advantages compared with traditional ones, because of the smaller amounts demands of organic solvent, reducing risks and process costs. It also proposes a study with 69 blood samples taken from living persons and post mortem blood samples, which were obtained by agreement with the Superintendency of São Paulo Scientific Technical Police (SPTC / SP). The methods developed were validated according to international guidelines of forensic interest. As a result of the validation, the methods developed were precise and accurate for amphetamine and cocaine. The limit of cocaine detection was 5 ng . mL-1 and the limit of quantification was 10 ng . mL-1. As for amphetamine, the limits of detection and quantification were 5 ng . mL-1. The HF-LPME technique was not applicable to tetrahydrocannabinol (Δ9-THC). As a result of the sample analysis, 40% of them presented positive results for cocaine. Of these, 35% were from blood samples taken from living persons and 64% from the post mortem blood samples. None of the samples presented quantifiable results for amphetamine.

In der vorliegenden Arbeit wurde die Leistungsfähigkeit der Hochleistungsflüssigchromatographie mit Photodiodenarraydetektion (HPLC-DAD) im Rahmen der Systematischen Toxikologischen Analyse (STA) umfassend untersucht, ein besonderer Schwerpunkt lag dabei auf der Aussagesicherheit bei der Substanzidentifizierung. Die Grundlage für diese Untersuchungen bildete die Messung der UV-Spektren und relativen Retentionszeiten (RRT) von 2.682 toxikologisch relevanten Substanzen mit Hilfe moderner Diodenarraydetektoren und unter einheitlichen experimentellen Bedingungen (Eluent: Acetonitril/ Phosphatpuffer pH 2,3; Trennsäule: Lichrospher RP8ec). Die erhaltenen Daten wurden zusammen mit weiteren Substanzinformationen in einer Spektrenbibliothek zusammengefasst, die als Buch und CD-ROM auch der Öffentlichkeit zugänglich gemacht wurde. Bei der Entwicklung eines Konzeptes zur Methodenvalidierung für die STA erwiesen sich insbesondere die Kenngrößen Selektivität und Spezifität als von zentraler Bedeutung. Unter Verwendung eines Fensteransatzes für die RRT und des Similarity Index (SI) für den Spektrenvergleich wurden sämtliche möglichen Substanzpaare aus der Spektrenbibliothek miteinander auf ihre Unterscheidbarkeit hin verglichen, wobei verschiedene RRT-Fensterbreiten und SI-Schwellenwerte zugrundegelegt wurden. Aus den Ergebnissen wurden Selektivitätsparameter wie die Relative Identification Power (RIP), die Discriminating Power (DP) und die Mean List Length (MLL) berechnet. Mit einer RIP von 84,2 %, einer MLL von 1,25 und einer DP von 0,9999 wurden für die Substanzidentifikation anhand von RRT + UV-Spektrum im Literaturvergleich sehr gute Ergebnisse erhalten. Die hohe Grad an Spezifität der UV-Spektren für den Einsatz in der STA wurde einerseits durch Auszählung sämtlicher in der Spektrenbibliothek gefundener Chromophore/Absorptionssysteme belegt: 1.650 verschiedene Absorptionssysteme wurden gefunden, über 60 % der Verbindungen trugen ein in diesem Substanzbestand einzigartiges Absorptionssystem. Andererseits wurde die computergestützte Unterscheidbarkeit zwischen verschiedenen Gruppen jeweils strukturell ähnlicher Wirkstoffe anhand des UV-Spektrums untersucht. Hierfür wurden 487 Substanzen in ein hierarchisches System von Haupt- und Untergruppen eingeteilt, zwischen denen anschließend mit Hilfe der Schrittweisen Diskriminanzanalyse (SDA) unterschieden werden sollte. Die sehr guten Klassifizierungsergebnisse und die Auflösung auch feiner struktureller Unterschiede, oftmals abseits des eigentlichen Absorptionssystems, lassen es grundsätzlich möglich erscheinen, auch Substanzen für die STA zu erschließen, die nicht in der Spektrenbibliothek enthalten sind. Insgesamt erwies sich die HPLC-DAD als hochselektives und -spezifisches Messverfahren, das zu Recht eine der wichtigsten STA-Methoden darstellt. / In this thesis the capability of high-performance liquid chromatography with photodiode array detection in the context of Systematical Toxicological Analysis (STA) was extensively investigated with a special focus on the certainty of substance identification. As the foundation for these investigations, UV spectra and relative retention times (RRT) of 2,682 toxicologically relevant compounds were recorded under uniform experimental conditions (mobile phase: acetonitrile/ phosphate buffer pH 2.3; column: Lichrospher RP8ec) using up-to-date photodiode array detectors. Together with additional substance information these data were built into a spectra library also made available to the public in the form of a book and a CD-ROM. During the development of a concept for the validation of a STA method, selectivity and specificity were found to be of central importance. Using a window approach for the RRT and the Similarity Index (SI) for spectral comparison, all possible substance pairs within the spectra library were examined in terms of their respective distinguishability, based on different RRT windows and SI threshold values. From the results selectivity parameters such as the Relative Identification Power (RIP), the Discriminating Power (DP), and the Mean List Length (MLL) were calculated. As compared to the literature, with a RIP of 84.2 %, a MLL of 1.25, and a DP of 0,9999 excellent results were obtained for the substance identification based on the combination of RRT and UV spectrum. The high degree of specificty of UV spectra for use in the STA was demonstrated on the one hand by counting all different chromophores/ absorption systems found in the spectra library: 1,650 systems were found, more than 60 % of the substances bore absorption systems unique in the dataset. On the other hand the computer-based distinction between different groups of structurally similar compounds on the basis of the UV spectrum was investigated by dividing 487 substances into a hierarchical system of main and subgroups and trying to distinguish between these groups using stepwise discriminant analysis (SDA). The highly satisfying classification results together with the resolution of fine structural differences, often remote from the actual absorption system, make it seem possible to also render substances not included in the spectra library accessible for the STA. In conclusion HPLC-DAD proved to be highly selective and specific, rightfully regarded as one of the most important STA methods.

Estima-se atualmente que mais de 5% da população mundial vem fazendo uso recreativo de algum tipo de substância psicoativa, sendo que o direito a esse uso é tema recorrente da sociedade contemporânea. Por apresentar riscos associados à saúde e a segurança das populações, o uso abusivo dessas substâncias tem instigado a toxicologia social na busca de respostas, com as quais se possa caracterizar, analisar e gerenciar esses riscos. Drogas de grande consumo no Brasil são a anfetamina, cocaína e Cannabis sativa. Esta tese desenvolveu uma nova metodologia para detectar e quantificar anfetamina, cocaína e tetrahidrocanabinol em sangue total, com uso de microextração em fase líquida via fibra de polipropileno (HF-LPME), seguida de cromatografia gasosa acoplada a espectrometria de massa (GC-MS). Trata-se de uma técnica que apresenta vantagens sobre as tradicionais, uma vez que demanda quantidades menores de solvente orgânico, diminuindo riscos e custos de processo. Também propôs um estudo com a aplicação dos métodos em 69 amostras de sangue de vivos e de post mortem, as quais foram obtidas por convênio com a superintendência da polícia técnica científica de São Paulo (SPTC/SP). Os métodos desenvolvidos foram validados de acordo com diretrizes internacionais de interesse forense. Como resultado da validação, os métodos desenvolvidos se mostraram precisos e exatos para anfetamina e cocaína. O limite de detecção da cocaína foi de 5 ng . mL-1 e o limite de quantificação de 10 ng . mL-1. Quanto a anfetamina, os limites de detecção e de quantificação foram de 5 ng . mL-1. A técnica de HF-LPME não foi aplicável ao tetraidrocanabinol (Δ9-THC). Como resultado da análise das amostras, 40% delas apresentaram resultados positivos para cocaína. Desses positivos, 35% foram oriundos das matrizes de sangue de vivos e 64% oriundos de sangue post mortem. Nenhuma delas apresentou resultado quantificável para anfetamina. / It is currently estimated that more than 5% of the world\'s population has been doing recreational use of some kind of psychoactive substances and the legal right to such use is a recurring theme debated by contemporary society. Due to the risks associated with populations health and safety, the abusive use of these substances has been instigating by social toxicology to search for answers to characterize, analyze and manage these risks. Drugs of great consumption in Brazil are, amphetamine cocaine and marijuana. This thesis proposes to develop a new methodology to detect and quantify psychoactive drugs in whole blood with the use of liquid phase microextraction by polypropylene fiber (HFLPME), followed by gas chromatography coupled to mass spectrometry (GC-MS). It is a technique that presents advantages compared with traditional ones, because of the smaller amounts demands of organic solvent, reducing risks and process costs. It also proposes a study with 69 blood samples taken from living persons and post mortem blood samples, which were obtained by agreement with the Superintendency of São Paulo Scientific Technical Police (SPTC / SP). The methods developed were validated according to international guidelines of forensic interest. As a result of the validation, the methods developed were precise and accurate for amphetamine and cocaine. The limit of cocaine detection was 5 ng . mL-1 and the limit of quantification was 10 ng . mL-1. As for amphetamine, the limits of detection and quantification were 5 ng . mL-1. The HF-LPME technique was not applicable to tetrahydrocannabinol (Δ9-THC). As a result of the sample analysis, 40% of them presented positive results for cocaine. Of these, 35% were from blood samples taken from living persons and 64% from the post mortem blood samples. None of the samples presented quantifiable results for amphetamine.

Die Systematische Toxikologische Analyse (STA) stellt auf Grund der großen Vielfalt und der ständigen Zunahme an toxikologisch relevanten Substanzen eine der größten Herausforderungen in der chemischen Analyse dar. In der vorliegenden Arbeit wurde daher die Eignung der Flüssigchromatographie in Kombination mit der Hybrid-Quadrupol-Flugzeitmassenspektrometrie (LC-QTOF-MS) für diesen Zweck untersucht. Dazu wurden eine Datenbank mit über 7360 und eine CID-Spektrenbibliothek mit mehr als 2720 toxikologisch relevanten Substanzen erstellt und geeignete Probenvorbereitungsmethoden entwickelt. Die Erprobung der Methoden erfolgte an dotierten Blut- und Haarproben. Hierbei zeigte sich, dass die Analyse im Auto-MS/MS-Modus (Messzyklen von MS- und MS/MS-Spektren) eine Identifizierung basischer Substanzen mittels CID-Spektren zwischen 0,5 und 2 ng/ml im Blut ermöglichte. Die Nachweisgrenzen der für 24 Wirkstoffe validierten Methode in Haaren lagen bei 3 bis 15 pg/mg. Die Eignung der LC-QTOF-MS zur STA von Haarproben wurde an 30 Drogentodesfällen und 60 Todesfällen mit bekannter chronischer Medikamenteneinnahme zu Lebzeiten sowie an 77 Blutproben nachgewiesen. Für die Suche nach Metaboliten wurde ein Metaboliten-Tool entwickelt. In der praktischen Anwendung auf Datenfiles von Blut- und Haarproben erwies sich das Tool als wertvolles Hilfsmittel zur Identifizierung unbekannter Peaks und zur Bestätigung von Suchergebnissen in der Datenbank. Zur automatischen Konzentrationsabschätzung identifizierter Substanzen wurde ein Tool „Estimate Concentration“ geschaffen. Die Überprüfung des Verfahrens an realen Blut- und Haarproben durch Vergleich mit HPLC-DAD- und GC-MS-Ergebnissen wies eine gute Übereinstimmung der Konzentrationen auf. Insgesamt zeigten die Untersuchungen, dass die LC-QTOF-MS zurzeit die am besten geeignete Methode für die STA darstellt. Auch bei einem erst später aufkommenden Verdacht kann eine gezielte Suche in dem bereits gemessenen Datenfile durchgeführt werden. / Due to the large variety and the steady increase of toxicologically relevant substances, systematic toxicological analysis (STA) is one of the most difficult tasks in analytical chemistry and, therefore, a steady topic of research and methodical improvement. For this reason, the suitability of liquid chromatography in combination with hybrid quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) for STA was investigated. For this purpose, a database of more than 7360 and a CID spectra library of more than 2720 toxicologically relevant substances and suitable methods for sample preparation were developed. The application was evaluated at spiked blood and hair samples. It was found that the analysis in Auto-MS/MS mode (alternating measurement cycles of MS and MS/MS spectra) allowed substance identification in blood using CID spectra between 0.5 and 2 ng/ml for basic substances. The detection limits of the validated method in hair ranged from 3 to 15 pg/mg for 24 drugs. The suitability of LC-QTOF-MS for STA was tested for hair samples from 30 drug-related death cases and from 60 death cases with known chronic medication as well as for 77 blood samples. For the search of metabolites, a metabolite tool was developed. In the practical application to data files from blood and hair samples, the tool proved to be very helpful for identification of unknown peaks and for confirmation of results obtained only from the database without CID spectra. A tool "Estimate Concentration" was created for automatic estimation of concentrations of identified substances. The application to real blood and hair samples and the comparison of the concentrations with results from HPLC-DAD and GC-MS showed good agreement. Overall, these investigations showed that LC-QTOF-MS is currently the most favorable method for STA. Because of the comprehensive registration of all substances in a sample, the data files can be checked for the presence of certain poisons even later without new measurements.