Stéphane Pirnay

Interaction of drugs of abuse and maintenance treatments with human P-glycoprotein (ABCB1) and breast cancer resistance protein (ABCG2)

Drug interaction with P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) may influence its tissue disposition including blood-brain barrier transport and result in potent drug-drug interactions. The limited data obtained using in-vitro models indicate that methadone, buprenorphine, and cannabinoids may interact with human P-gp; but almost nothing is known about drugs of abuse and BCRP. We used in vitro P-gp and BCRP inhibition flow cytometric assays with hMDR1- and hBCRP-transfected HEK293 cells to test 14 compounds or metabolites frequently involved in addiction, including buprenorphine, norbuprenorphine, methadone, ibogaine, cocaine, cocaethylene, amphetamine, N-methyl-3,4-methylenedioxyamphetamine, 3,4-methylenedioxyamphetamine, nicotine, ketamine, Delta9-tetrahydrocannabinol (THC), naloxone, and morphine. Drugs that in vitro inhibited P-gp or BCRP were tested in hMDR1- and hBCRP-MDCKII bidirectional transport studies. Human P-gp was significantly inhibited in a concentration-dependent manner by norbuprenorphine>buprenorphine>methadone>ibogaine and THC. Similarly, BCRP was inhibited by buprenorphine>norbuprenorphine>ibogaine and THC. None of the other tested compounds inhibited either transporter, even at high concentration (100 microm). Norbuprenorphine (transport efflux ratio approoximately 11) and methadone (transport efflux ratio approoximately 1.9) transport was P-gp-mediated; however, with no significant stereo-selectivity regarding methadone enantiomers. BCRP did not transport any of the tested compounds. However, the clinical significance of the interaction of norbuprenorphine with P-gp remains to be evaluated.

Does High-Dose Buprenorphine Cause Respiratory Depression? Possible Mechanisms and Therapeutic Consequences

Buprenorphine is an opioid agonist-antagonist with a ‘ceiling effect’ for respiratory depression. Compared with methadone, its unique pharmacology offers practical advantages and enhanced safety when prescribed as recommended and supervised by a physician. Buprenorphine has been approved in several countries as an efficient and safe maintenance therapy for heroin addiction. Its use resulted in a salutary effect with a reduction in heroin overdose-related deaths in countries that implemented office-based buprenorphine maintenance. In France, however, where high-dose buprenorphine has been marketed since 1996, several cases of asphyxic deaths were reported among addicts treated with buprenorphine. Death resulted from buprenorphine intravenous misuse or concomitant sedative drug ingestion, such as benzodiazepines. In these situations of abuse, misuse, or in association with elevated doses of psychotropic drugs, buprenorphine may cause severe respiratory depression. Unlike other opiates, the respiratory effects from buprenorphine are not responsive to naloxone. However, the exact mechanism of buprenorphine-induced effects on ventilation is still unknown. The role of norbuprenorphine, the main N-dealkylated buprenorphine metabolite with potent respiratory depressor activity, also remains unclear. Experimental studies investigating the respiratory effects of combinations of high doses of buprenorphine and benzodiazepines suggested that this drug-drug interaction may result from a pharmacodynamic interaction. A pharmacokinetic interaction between buprenorphine and flunitrazepam is also considered. As there are many questions regarding the possible dangers of death or respiratory depression associated with buprenorphine use, we aimed to present a comprehensive critical review of the published clinical and experimental studies on buprenorphine respiratory effects.

Effects of Various Combinations of Benzodiazepines with Buprenorphine on Arterial Blood Gases in Rats

Fatalities have been attributed to combinations of high-dose buprenorphine with benzodiazepines. In rats, high-dose buprenorphine combined with midazolam was shown to induce sustained respiratory acidosis, while buprenorphine alone did not. However, the effects of buprenorphine combined with pharmacological doses of benzodiazepines remain unknown. Our objective was to compare the acute effects of four selected benzodiazepines used intravenously at equi-efficacious doses in rats, alone and in combination with buprenorphine on sedation, respiratory rate and arterial blood gases. Buprenorphine (30 mg/kg) did not significantly modify sedation level or respiratory rate, but induced mild and transient effects on pH and PaCO(2) (P < 0.05). Similarly, despite having no effects on respiratory rate, nordiazepam (10 mg/kg), bromazepam (1 mg/kg) and oxazepam (12 mg/kg) mildly and transiently altered pH and PaCO(2) (P < 0.05), whereas clonazepam (5 mg/kg) did not. Buprenorphine combined with each benzodiazepine induced no significant effects on respiratory rate or blood gases, in comparison with buprenorphine alone. However, combinations of oxazepam or nordiazepam with buprenorphine significantly deepened sedation. While both combinations reduced respiratory rate, buprenorphine + 30 mg/kg clonazepam significantly increased PaCO(2) and buprenorphine + 30 mg/kg nordiazepam decreased PaO(2). In conclusion, not all benzodiazepines induce significant respiratory depression at therapeutic doses. We were unable to demonstrate significant effects on rat ventilatory parameters of buprenorphine combined with equi-efficacious pharmacological doses of benzodiazepines in comparison with buprenorphine alone. Our results may suggest that effects of these combinations are rather mild. Respiratory failure may, however, result from the association of buprenorphine with elevated doses of benzodiazepines.

Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow

Assessing brain death may sometimes be difficult, with isoelectric EEG following psychotrope overdoses or normal cerebral blood flow (CBF) persisting despite brain death in the case of ventricular drainage or craniotomy. A 42-year-old man, resuscitated after cardiac arrest following a suicidal ingestion of ethanol, bromazepam and zopiclone, was admitted in deep coma. On day 4, his brainstem reflexes and EEG activity disappeared. On day 5, his serum bromazepam concentration was 817 ng/ml (therapeutic: 80-150). The patient was unresponsive to 1 mg of flumazenil. MRI showed diffuse cerebral swelling. CBF assessed by angiography and Doppler remained normal and EEG isoelectric until he died on day 8 with multiorgan failure. There was a discrepancy between the clinically and EEG-assessed brain death, and CBF persistence. We hypothesized that brain death, resulting from diffuse anoxic injury, may lead, in the absence of major intracranial hypertension, to angiographic misdiagnoses. Therefore, EEG remains useful to assess diagnosis in such unusual cases.

Adsorption–desorption effects in ion trap mass spectrometry using in situ ionization

Quadrupole mass spectrometers were compared for the GC-MS analysis of six molecules frequently encountered in analytical toxicology: diazepam, alprazolam, triazolam, LSD (lysergic acid diethylamide), trimethylsilylated LSD and trimethylsilylated buprenorphine. Experiments performed with ion trap detectors using in situ ionization led to important chromatographic peak tailing for the most polar compounds; it was assumed to result from adsorption-desorption of neutral molecules in the mass spectrometer. This study showed that the degree of peak tailing is correlated with analyte polarity, with materials coating ion trap surfaces and with analysis temperature and that this anomaly can be greatly reduced using passivated surfaces and a high temperature of analysis.

Predictive microbiology for cosmetics based on physicals, chemicals and concentration parameters

Challenge test (CT) is essential to assure the efficiency of the preservative system in products. A previous study realized by our staff in 2012, carried out to evaluate the influence of three parameters (ethanol, pH and water) on the microbiological cosmetics products conservation. Following this work, a correlation between aw (based on the glycerine concentration) and the selected parameter has been demonstrated. In the present study, smaller limits of ethanol, pH and glycerine were applied to determinate CT necessity.

Letter: In situ chemical ionization in ion trap mass spectrometry—the beneficial influence of isobutane as a reagent gas

We report a comparison of the ionization yields provided by the most common reagents (methane, ammonia, methanol, acetonitrile and isobutane) performing in situ chemical ionization with an ion trap mass spectrometer. Four molecules were chosen in the medical field to illustrate experimental results: alprazolam, diazepam, flunitrazepam and acetaminophen. Under usual operational conditions, relative abundances of protonated ions appreciably depend on the reagents. The greatest abundance of MH+ ions was obtained with isobutane while observed intensities for MH+ ions varied from 73% for methanol and ammonia to about 23% for acetonitrile and methane. Results were rationalized comparing energies of formation of the reagent ions and storage efficiency in the trapping field.

UV–vis degradation of α-tocopherol in a model system and in a cosmetic emulsion—Structural elucidation of photoproducts and toxicological consequences

The UV-vis photodegradation of α-tocopherol was investigated in a model system and in a cosmetic emulsion. Both gas chromatography coupled with tandem mass spectrometry (GC-MS/MS) and high performance liquid chromatography coupled with ultrahigh resolution Fourier transform ion cyclotron resonance mass spectrometry (LC-UHR-MS) were used for photoproducts structural identification. Nine photoproduct families were detected and identified based on their mass spectra and additional experiments with α-tocopherol-d9; phototransformation mechanisms were postulated to rationalize their formation under irradiation. In silico QSAR (Quantitative Structure Activity Relationship) toxicity predictions were conducted with the Toxicity Estimation Software Tool (T.E.S.T.). Low oral rat LD50 values of 466.78mgkg-1 and 467.9mgkg-1 were predicted for some photoproducts, indicating a potential toxicity more than 10 times greater that of α-tocopherol (5742.54mgkg-1). In vitro assays on Vibrio fischeri bacteria showed that the global ecotoxicity of the α-tocopherol solution significantly increases with irradiation time. One identified product should contribute to this ecotoxicity enhancement since in silico estimations for D. magna provide a LC50 value 4 times lower than that of the parent molecule.

Validation of analytical method for the quantitative determination of preservative acids allowed in Eco label cosmetic products

Preservation of a natural cosmetic product should logical be ensured by a natural way. Because of the difficulty of defined properly the efficiency of natural preservatives (absence of minimum inhibitory concentration (MIC), absence of toxicological data) some synthetic preservatives are authorized by labels for their occurrence in nature, their low toxicity and their limited irritant or allergenic reactions. The main synthetic preservatives allowed in natural products are: benzyl alcohol, benzoic acid and its salts, dehydroacetic acid and its salts, salicylic acid and its salts, sorbic acid and its salts (Table 1). These compounds are allowed in finished cosmetic products by the European Commission, in Annex V of the cosmetics Regulation No. 1223/2009 with maximum permitted concentrations between 0.5% and 2.5% (Table 2). In this context, EXPERTOX laboratory has developed and validated an LC-UV analytical method for the determination and quantification of four acid preservatives in cosmetic products as part of a quality control and in compliance with the Regulation No. 1223/2009. Benzyl alcohol quantification assay by GC-MS was already validated by the laboratory to determinate allergens in cosmetic product.6 The compliance within the authorized concentrations in the final product is intended to ensure good preservation and stability of cosmetics, and there ensure consumer safety.

Optimization of the method of the content-containing interaction evaluation for cosmetic products by gas chromatography-mass spectrometry

In July 2013, the European Regulation (EC) No 1223/2009 came into effect in order to secure cosmetic products. The content‐containing interaction between the packaging and the product must be considered for the safety assessment. Indeed, some compounds are able to migrate from the packaging to the product and may be harmful to the consumer health. This is why a first test was established by EXPERTOX laboratory in 2012 to deal with this new regulation. A new analytical method was developed and validated for the quantification of 23 substances able to migrate from the packaging to the product. It was applied on a plastic packaging with the five simulants of migration. To evaluate the content‐containing interaction, a gas chromatography‐mass spectrometry method was developed and validated. Liquid–liquid extraction was used to extract contaminants (thirteen phthalates and ten substances of very high concern) from migration simulants. Calibration curves showed good linearity regression from 2 to 50 μg mL−1 for nineteen molecules and from 5 to 45 μg mL−1 for the others. The limits of quantification were respectively 2 and 5 μg mL−1. The accuracy, precision, repeatability of the analytical method and extraction yields were acceptable. No molecule was found in simulants of migration, so the potential contaminants present in the packaging did not migrate. A gas chromatography‐mass spectrometry method and liquid‐liquid extraction were validated for 23 molecules and can be used for the evaluation of the content‐containing interaction of cosmetic products. Both quantification and extraction procedures are more robust and faster than previous method.