Because either trough or peak concentration at 2 h after administration is measured in routine therapeutic drug monitoring for cyclosporine A (CyA), a quantification method with a wide-range calibration curve capable of simultaneously measuring both concentrations is required. We developed a sensitive, wide-range and highthroughput quantification method for CyA in whole blood using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), and compared patients' blood CyA levels measured by UPLC-MS/MS and antibody-conjugated magnetic immunoassay (ACMIA). Whole blood samples were prepared by solid-phase extraction using Oasis HLB μElution plate. The UPLC-MS/MS assay showed excellent linearity over a wide calibration range of 5-2500 ng/mL. Within-batch accuracy and precision as well as batch-to-batch accuracy and precision fulfilled the criteria of US Food and Drug Administration guidelines. The blood CyA concentrations measured by the UPLC-MS/MS assay correlated strongly with those measured by ACMIA. A Bland-Altman plot showed a fixed error between CyA concentrations measured by the two methods, and the concentrations measured by the UPLC-MS/MS method were consistently lower than those measured by ACMIA. We have succeeded to develop a sensitive, wide-range and high-throughput quantification method for CyA in whole blood using UPLC-MS/MS.
K E Y W O R D Santibody-conjugated magnetic immunoassay, cyclosporine, therapeutic drug monitoring, ultraperformance liquid chromatography-tandem mass spectrometry
| INTRODUCTIONCyclosporine A (CyA) is a calcineurin inhibitor and exhibits immunosuppressive effect by inhibiting cytokines, particular interleukin-2, which are secreted by T lymphocytes (Taylor et al., 2005). Like tacrolimus, CyA is an important immunosuppressant used in various organ transplantations and autoimmune diseases (Kaufman et al., 2004). CyA has strong pharmacological activity at low doses, but its therapeutic window is narrow. Furthermore, due to the large intra-and inter-individual variability in pharmacokinetics as well as significant disposition in erythrocytes,