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现代治疗药物监测和脂质组学方法在临床实践中的应用:以黏菌素治疗为例的案例研究

Implementation of Modern Therapeutic Drug Monitoring and Lipidomics Approaches in Clinical Practice: A Case Study with Colistin Treatment.

作者信息

Gerhardtova Ivana, Cizmarova Ivana, Jankech Timotej, Olesova Dominika, Jampilek Josef, Parrak Vojtech, Nemergutova Kristina, Sopko Ladislav, Piestansky Juraj, Kovac Andrej

机构信息

Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta 9, 845 10 Bratislava, Slovakia.

Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University Bratislava, Ilkovicova 6, 842 15 Bratislava, Slovakia.

出版信息

Pharmaceuticals (Basel). 2024 Jun 7;17(6):753. doi: 10.3390/ph17060753.

Abstract

Nowadays, lipidomics plays a crucial role in the investigation of novel biomarkers of various diseases. Its implementation into the field of clinical analysis led to the identification of specific lipids and/or significant changes in their plasma levels in patients suffering from cancer, Alzheimer's disease, sepsis, and many other diseases and pathological conditions. Profiling of lipids and determination of their plasma concentrations could also be helpful in the case of drug therapy management, especially in combination with therapeutic drug monitoring (TDM). Here, for the first time, a combined approach based on the TDM of colistin, a last-resort antibiotic, and lipidomic profiling is presented in a case study of a critically ill male patient suffering from -induced pneumonia. Implementation of innovative analytical approaches for TDM (online combination of capillary electrophoresis with tandem mass spectrometry, CZE-MS/MS) and lipidomics (liquid chromatography-tandem mass spectrometry, LC-MS/MS) was demonstrated. The CZE-MS/MS strategy confirmed the chosen colistin drug dosing regimen, leading to stable colistin concentrations in plasma samples. The determined colistin concentrations in plasma samples reached the required minimal inhibitory concentration of 1 μg/mL. The complex lipidomics approach led to monitoring 545 lipids in collected patient plasma samples during and after the therapy. Some changes in specific individual lipids were in good agreement with previous lipidomics studies dealing with sepsis. The presented case study represents a good starting point for identifying particular individual lipids that could correlate with antimicrobial and inflammation therapeutic management.

摘要

如今,脂质组学在各种疾病新型生物标志物的研究中发挥着关键作用。将其应用于临床分析领域,使得在癌症、阿尔茨海默病、败血症以及许多其他疾病和病理状况的患者中,能够识别特定脂质和/或其血浆水平的显著变化。脂质分析及其血浆浓度的测定在药物治疗管理中也可能有所帮助,特别是与治疗药物监测(TDM)相结合时。在此,首次在一名患有呼吸机相关性肺炎的重症男性患者的病例研究中,提出了一种基于多粘菌素(一种急救抗生素)的TDM和脂质组学分析的联合方法。展示了用于TDM(毛细管电泳与串联质谱联用,CZE-MS/MS)和脂质组学(液相色谱-串联质谱,LC-MS/MS)的创新分析方法的应用。CZE-MS/MS策略证实了所选的多粘菌素给药方案,使血浆样本中的多粘菌素浓度保持稳定。血浆样本中测定的多粘菌素浓度达到了所需的1 μg/mL最低抑菌浓度。复杂的脂质组学方法使得在治疗期间和治疗后对收集的患者血浆样本中的545种脂质进行了监测。特定个体脂质的一些变化与先前关于败血症的脂质组学研究结果高度一致。所呈现的病例研究是识别可能与抗菌和炎症治疗管理相关的特定个体脂质的良好起点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6fb/11206893/9ff56695b712/pharmaceuticals-17-00753-g001.jpg

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